Operative microwave ablation for hepatocellular carcinoma: a single center retrospective review of 219 patients

Abstract

Background: Microwave ablation (MWA) of hepatocellular carcinoma (HCC) offers local regional treatment that can be safely and effectively performed, even in patients with advanced liver disease. We update results from our group's previous analysis of operative MWA for HCC. Results: Two hundred and nineteen patients were included with a total of 340 tumors treated with operative MWA. Median tumor size was 3.2 cm (range, 1-6 cm). Cirrhosis was present in 89.5% of patients, 60.7% had hepatitis C, and 8.2% had hepatitis B. Thirty-five point nine percent were Child-Pugh class B/C. Ninety-six point eight percent of MWA procedures were performed laparoscopically. Four deaths occurred within 30 days (1.8%). Clavien-Dindo grade III complications occurred in 3.2% of patients. Complete ablation was identified in 97.1% of tumors, with local recurrence rates of 8.5% at 10.9 months median follow up (0-80 months). Regional recurrence occurred in 34.8% of patients at 10.9 months median follow up and metastatic recurrence was seen in 8.1% of patients. One year overall survival was 80.0% and 2-year survival was 61.5%. Conclusions:We propose that laparoscopic MWA offers a low morbidity approach for treatment of HCC affording low rates of local recurrence even for patients with significant underlying liver dysfunction. This large series offers insight into outcomes of this modality as definitive treatment for patients with HCC.

Videolaparoscopic microwave ablation in patients with HCC at a European high‐volume center: Results of 815 procedures

“…In considering our 0.4% in-hospital mortality rate, the sample's heterogeneous hepatic functional reserve should be taken into account (Child range, 5-9; MELD range, 6-23). This figure is in line with previously reported series of VLA, 7,26,39,40 and close to the 0.3% described in some studies after percutaneous ablation. 41 It nonetheless goes to show that further efforts should be made to improve patient selection in the future.…”

“…34 In a cohort of 1136 patients with liver malignancies treated with percutaneous ablation, bile duct injury occurred in 0.2% (2 cases); 35 and 2 cases (0.2%) were seen in our series too. Our median postoperative hospital stay (2 days) was either similar to other experiences, 26 or shorter, 9,[36][37][38] underscoring the considerable benefit of minimally invasive approaches, even in a sample with a high prevalence of intermediate-grade cirrhosis (32.8% Child B).…”

“…In our experience, local tumor recurrences occurred in 23.2% of cases. Baker et al recently reported a local recurrence rate of 8.5% in a retrospective study on 219 patients. Such a marked discrepancy may reflect differences in technical aspects, the amount of energy delivered, and possibly in the quality of the event detection processes.…”

“…The safety of VLA for HCC had so far been reported for series of no more than 267 patients treated with RFA, and 203 treated with MWA . The vast majority of the complications described to date (in 2% to 45% of patients treated with VL RFA, and in 16% to 62% of those treated with VL MWA) were minor.…”

“…MWA. 26 The vast majority of the complications described to date (in 2% to 45% of patients treated with VL RFA, 6,7,[27][28][29][30] and in 16% to 62% of those treated with VL MWA) 6,7,31 were minor. The use of MWA has nonetheless been widely questioned because of the potentially higher risk of major biliary damage associated with the greater amount of energy delivered.…”