Efficacy and Safety of Microwave Ablation (MWA) for Hepatocellular Carcinoma (HCC) in Difficult Anatomical Sites in Egyptian Patients with Liver Cirrhosis

Abstract

Background and aim: Imaging guided microwave ablation (MWA) for hepatocellular carcinoma (HCC) has become a widely used method over recent years. Tumors close to the diaphragm, gastrointestinal tract, gallbladder, pancreas, hepatic hilum and major bile duct or vessels are generally considered relative contraindications for microwave ablation. This study was conducted to assess the effectiveness and safety of ultrasonography-guided MWA in treating patients with HCC in difficult anatomical sites in comparison to those in conventional sites. Patients and methods: Eighty-eight patients were included and divided into two groups: the study group of 44 with 46 lesions lying <5mm from the diaphragm, hepatic capsule, gall bladder (GB) or large vessel; and the control group of 44 patients with 50 lesions in non-risky sites. Each lesion was ablated using an ultrasound guided microwave probe using a detailed protocol. Results: Most of the patients were males, with a mean age of 57.8 years. In the study group, two patients had lesions adjacent to the GB, twelve were perivascular and 32 were subcapsular. The overall successful ablation rates were 84.8% and 92% in the study and control groups, respectively. Within the study group, ablation rates were 100%, 75% and 87.5% for lesions close to the GB, perivascular lesions and subcapsular lesions, respectively. One patient developed a subcutaneous abscess, with good outcome after proper treatment. Fever, pain and asymptomatic pleural effusion were reported after ablation without statistically significant difference between the groups or among subgroups. In conclusion: MWA for HCC in difficult anatomical sites is as effective and safe as for ordinary sites.

Evaluation of GALAD Score in Diagnosis and Follow-up of Hepatocellular Carcinoma after Local Ablative Therapy

“…The finding was in accordance with studies conducted by Choi et al 22 and Amoros et al 27 Regarding baseline laboratory data and Child-Pugh classification, the patients with HCC had increased albumin and normal bilirubin levels, nearly normal prothrombin time, and were more likely to be Child-Pugh class A compared with the control group. The better liver biochemical profile might be explained by the selection bias of well-compensated HCC cases to allow for therapeutic intervention, and consistent with the findings of Johnson et al, 15 Soliman et al, 18 and Best et al 28 Our study has several strengths. The most important is the study of cases with early-stage tumors, where 31.30% of the included focal lesions were less than 2 cm in diameter with curative potential.…”

Percutaneous Microwave Ablation of Liver Lesions: Differences on the Sphericity Index of the Ablation Zone between Cirrhotic and Healthy Liver Parenchyma

“…Advantages of the MWA systems include the aptitude to reach higher temperatures and greater ablation zones in less time, with less heat sink effect when compared to RF ablation [ 4 , 5 , 6 ]. When compared to other heat based ablation techniques, microwaves are more effective in tissues with high blood circulation or near vascular structures with resultant ablation zones being relatively unvarying in shape and size and more predictable in extension [ 7 , 8 ].…”

Unique situation of hepatocellular carcinoma in Egypt: A review of epidemiology and control measures

“…MWA ablation provides better results in areas with high blood flow, or near vessels, because it is not affected by the heat sink effect[ 141 ]. An Egyptian study carried out by Soliman et al [ 142 ] aimed to investigate the efficacy of MWA ablation in risky areas adjacent to other organs, near the diaphragm, and near blood vessels. In the study group, MWA reached ablation rates of 100%, 75%, and 87.5% for lesions close to the gall bladder, perivascular lesions, and subcapsular lesions, respectively.…”