Local Anesthesia vs. General Anesthesia for Percutaneous Microwave Ablation in Hepatocellular Carcinoma, an Efficacy, Safety, and Cost Analysis

Abstract

Purpose: To compare the efficacy, safety, and cost between local anesthesia and general anesthesia modality for percutaneous microwave ablation in hepatocellular carcinoma patients who received combination therapy for curative treatment purposes.Methods: This comparative, retrospective analysis analyzed 175 patients treated for hepatocellular carcinoma (HCC) from July 2015 to September 2020. Patients were divided into two cohorts according to the anesthesia modality applied during the percutaneous microwave ablation (MWA) procedure. To investigate the differences in efficacy between the two groups, overall survival (OS) and local recurrence-free survival (LRFS) were estimated by the Kaplan-Meier method and compared by the log-rank test. Propensity score matching (PSM) was performed using a caliper width of 0.2 between two groups. Cost and safety between the two groups were also compared accordingly.Results: There was 105 patients with 128 HCC lesions in the local anesthesia (LA) group while 70 patients with 107 lesions in the general anesthesia (GA) group. No significant differences in OS (P=0.798) and LRFS (P=0.406) between the two groups. 51 pairs of patients were matched with 78 lesions in the GA group and 68 lesions in the LA group after PSM. There were no significant differences in the OS (P=0.522) and LRFS (P=0.410) between the two groups as well. Compared to the LA group, there was more MWA procedure time spent, medical resources consumption, and financial stress undertaken in the GA group. However, no statistical differences were observed in post-ablation pain, adverse events, and complications between the two groups. Conclusion: Due to the higher cost of general anesthesia, local anesthesia may be more adaptive during ablation procedure for HCC patients within Milan criteria.