Laparoscopic Microwave Ablation of Hepatocellular Carcinoma at Liver Surface: Technique Effectiveness and Long-Term Outcomes

Abstract

Background and Aims:To evaluate long-term outcomes and prognostic factors of laparoscopic microwave ablation as a first-line treatment for hepatocellular carcinoma located at the liver surface not feasible for percutaneous ablation.Methods:51 consecutive patients receiving laparoscopic microwave ablation in our center between January 11, 2012, and July 31, 2014, were enrolled. Technique effectiveness (complete ablation or incomplete ablation) was evaluated 1 month postprocedure. Procedure-related complications were recorded. The influences of patients’ baseline characteristics on recurrence-free survival and overall survival were analyzed after a median follow-up of 34.0 (ranging 19.0-49.0) months.Results:Complete ablation was gained in 47 (92.2%) of the 51 patients. No patients died within 30 days of microwave ablation procedure. A total of 3 (5.9%) cases of complications were observed. Tumor progression/recurrence were observed in 40 patients (78.4%). The median recurrence-free survival and median overall survival of the total cohort was 11.0 months (95% confidence interval: 7.573-14.427) and 34.0 months (95% confidence interval: 27.244-40.756), respectively. Multivariate analysis identified alanine transaminase level and tumor number as independent significant prognosticators of recurrence-free survival whereas α-fetoprotein level as significant prognosticators of overall survival.Conclusions:As a first-line treatment, laparoscopic microwave ablation provides high technique effectiveness rate and is well tolerated in patients with hepatocellular carcinoma located at liver surface. Alanine transaminase and tumor number were significant predictors of recurrence-free survival, whereas α-fetoprotein level was significant predictor of overall survival. Laparoscopic microwave ablation might serve as a rational treatment option for patients with hepatocellular carcinoma with tumors at the liver surface, which merits validation in future perspective studies.

Minimally invasive microwave ablation provides excellent long‐term outcomes for otherwise inaccessible hepatocellular cancer

“…Similar to the present study, Wang et al 32 reported outcomes on 51 patients who underwent MWA with a minimally invasive approach. With a follow‐up of 34 months, disease progression or recurrence was observed in 78.4% of patients 32 . The median recurrence‐free survival was 11 months, and the median overall survival was 34 months 32 .…”

“…This study showed that in a small subset of patients laparoscopic MWA was safe and efficacious with outcomes comparable with RFA 31 . Another recent study further evaluated MIS for MWA in HCC 32 . Similar to the present study, Wang et al 32 reported outcomes on 51 patients who underwent MWA with a minimally invasive approach.…”

“…Another recent study further evaluated MIS for MWA in HCC 32 . Similar to the present study, Wang et al 32 reported outcomes on 51 patients who underwent MWA with a minimally invasive approach. With a follow‐up of 34 months, disease progression or recurrence was observed in 78.4% of patients 32 .…”

“…With a follow‐up of 34 months, disease progression or recurrence was observed in 78.4% of patients 32 . The median recurrence‐free survival was 11 months, and the median overall survival was 34 months 32 . In the present study, we report a lower rate of recurrence and longer overall survival with a longer median follow‐up, which may in part be due to patient selection and/or surgical technique.…”

Chimeric Antigen Receptor-Glypican-3 T-Cell Therapy for Advanced Hepatocellular Carcinoma: Results of Phase I Trials

“…Considerable challenges exist in the clinical management of HCC. Only 15% to 20% of HCC cases are diagnosed at an early stage that may be suitable for curative treatment, such as surgical resection, liver transplantation, local ablation with percutaneous ethanol injection, microwave ablation, and radiofrequency ablation (4)(5)(6)(7). Meanwhile, the majority of patients with HCC have underlying chronic liver disease, and resection in this population is fraught with the potential for complications.…”