Textbook Outcome of Laparoscopic Microwave Ablation for Hepatocellular Carcinoma

Abstract

In the context of spreading interest in textbook outcome (TO) evaluation in different fields, we aimed to investigate an uncharted procedure, that is, laparoscopic microwave ablation (MWA) for hepatocellular carcinoma (HCC). Absence of post-MWA complications, a hospital stay of three days, no mortality nor readmission within 30 days, and complete response of the target lesion at post-MWA CT scan defined TO achievement. Patients treated between January 2014 and March 2021 were retrospectively reviewed, and of the 521 patients eligible for the study, 337 (64.7%) fulfilled all the quality indicators to achieve the TO. The absence of complications was the main limiting factor for accomplishing TO. At multivariable analysis, Child–Pugh B cirrhosis, age of more than 70 years old, three nodules, and MELD score ≥ 15 were associated with decreased probabilities of TO achievement. A score based on these factors was derived from multivariable analysis, and patients were divided into three risk groups for TO achievement. At survival analysis, overall survival (OS) was significantly (p = 0.001) higher in patients who achieved TO than those who did not. Moreover, OS evaluation in the three risk groups showed a trend coherent with TO achievement probability. The present study, having assessed the first TO for laparoscopic MWA for HCC, encourages further broader consensus on its definition and, on its basis, on the development of clinically relevant tools for managing treatment allocation.

What Is the Role of Minimally Invasive Liver Surgery in Treating Patients with Hepatocellular Carcinoma on Cirrhosis?

“…Recently, an Italian study reported that when textbook outcomes are reached, LA may indeed prove to be a curative therapy [ 69 ]. The same study group conducted a large multicenter study (as yet unpublished), comparing three cohorts of patients undergoing pRFA, laparoscopic microwave ablation (LA), or TACE.…”

“…Finally, tumor ablation using LA is considered hierarchically superior to TACE, so before deciding to use intra-arterial therapy, the feasibility of LA should be considered [ 68 , 69 ]. This novel operative framework is fashioned to assist the decision-making of experts in the setting of a multidisciplinary meeting.…”