Therapeutic efficacy of percutaneous microwave coagulation versus liver resection for single hepatocellular carcinoma ≤3 cm with Child-Pugh A cirrhosis

Zhang, E.-L.; Yang, Fuquan; Wu, Z.-B.; Yue, Chaosen; He, Tao; Li, K.-Y.; Xiao, Zhenyu; Xiong, Min; Chen, X.-P.; Huang, Zhiyong

doi:10.1016/j.ejso.2016.02.251

Cited by 21 publications

(27 citation statements)

References 37 publications

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“…Of those, 16 were excluded because the studies reported the wrong intervention/comparator ( n = 10), reported irrelevant outcomes ( n = 1), did not report outcomes by treatment ( n = 2), were systematic reviews ( n = 1), were duplicates ( n = 1), and involved the wrong population ( n = 1). Sixteen studies that enrolled a total of 2522 patients were included in the meta-analysis [3, 4, 6, 7, 11–17, 24–28]. Study characteristics are presented in Table 1.…”

Section: Resultsmentioning

confidence: 99%

“…Most studies drew the group receiving HR from the same source as the MWA or MWA + HR groups. However, some studies indicated that there were criteria for assigning patients with certain characteristics (e.g., age, tumor location, presence of comorbidities, tumor resectability, or patient/physician preference) to the different treatments [3, 6, 7, 13, 15, 17, 26, 28]. These studies were categorized as having the non-exposed cohort (HR group) drawn from a different source and were not given a star due to allocation bias.…”

Section: Resultsmentioning

confidence: 99%

“…MWA uses electromagnetic fields of either 915 or 2450 MHz to heat tissue to extreme temperatures resulting in the destruction of tumor cells surrounding the microwave antenna [5]. MWA is less invasive than HR [6, 7], but the margins achievable for tumors treated with HR are usually wider than those treated with MWA.…”

Section: Introductionmentioning

confidence: 99%

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Microwave ablation compared with hepatic resection for the treatment of hepatocellular carcinoma and liver metastases: a systematic review and meta-analysis

Glassberg¹,

Ghosh²,

Clymer³

et al. 2019

World J Surg Onc

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Background Hepatic resection (HR) is the gold standard liver cancer treatment, but few patients are eligible due to comorbidities or tumor location. Microwave ablation (MWA) is an important complementary liver cancer treatment to HR. This systematic review compared MWA with HR for liver cancer treatment. Methods A systematic search of MEDLINE, EMBASE, and CENTRAL was conducted for randomized and observational studies published from 2006 onwards. The primary outcome was local tumor recurrence (LTR), and a random effects model was used for meta-analyses. Results Of the 1845 studies identified, 1 randomized and 15 observational studies met the inclusion criteria. LTR was significantly increased with MWA versus HR (risk ratio (RR) = 2.49; P = 0.016). In secondary measures, HR provided significantly higher 3- and 5-year overall survival (RR = 0.94; P = 0.03 and RR = 0.88; P = 0.01, respectively) and 3-year disease-free survival (RR = 0.78; P = 0.009). MWA exhibited significantly shorter length of stay (weighted mean difference (WMD) = − 6.16 days; P < 0.001) and operative time (WMD = − 58.69 min; P < 0.001), less intraoperative blood loss (WMD = − 189.09 mL; P = 0.006), and fewer complications than HR (RR = 0.31; P < 0.001). When MWA was combined with HR and compared with either modality alone, complications and blood loss were significantly lower with the combination treatment; however, there were no differences in other outcomes. Subgroup and sensitivity analyses were generally aligned with the main results. Conclusions MWA can be an effective and safe alternative to HR in patients/tumors that are not amenable to resection. More randomized and economic studies should be performed that compare the two treatments, especially to determine the target population that benefits most from MWA. Electronic supplementary material The online version of this article (10.1186/s12957-019-1632-6) contains supplementary material, which is available to authorized users.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Microwave ablation compared with hepatic resection for the treatment of hepatocellular carcinoma and liver metastases: a systematic review and meta-analysis

Glassberg¹,

Ghosh²,

Clymer³

et al. 2019

World J Surg Onc

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“…A previous comparison of PMCT treatment and surgical resection in HCC patients reported surgical resection to be the best option for treating patients with single, smaller (<3 cm diameter) tumors and PMCT to be a better choice for elderly HCC patients with comorbidities who were unable to tolerate surgery, as well as for HCC patients with portal hypertension, and for tumors located deep in the liver. [17] There has been a general trend toward less frequent use of aggressive strategies such as surgical resection, and more frequent use of less aggressive treatments for elderly patients. [21] When 2 less aggressive treatments, microwave ablation (the treatment used here) and radiofrequency ablation were used for HCC patients with multiple tumors, although both treatments damaged tumor cells by the same mechanism (thermal injury), microwave ablation had a more predictable ablation zone, caused more rapid coagulation, [3] and resulted in lower rates of tumor progression than radiofrequency ablation.…”

Section: Discussionmentioning

confidence: 99%

“…[1,3] A previous recent report showed no significant difference in overall survival (OS) and progression-free survival (PFS) between HCC patients with portal hypertension who received PMCT and those who underwent surgical resection. [17] HCC patients treated with PMCT also had a significantly better prognosis with less invasive tumors and fewer complications than patients who received laparoscopic resection. [15]…”

Section: Introductionmentioning

confidence: 99%

Clinical outcome in elderly Chinese patients with primary hepatocellular carcinoma treated with percutaneous microwave coagulation therapy (PMCT)

Shen

Tang

et al. 2018

Medicine

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Percutaneous microwave ablation therapy (PMCT) has been recommended for elderly hepatocellular carcinoma (HCC) patients who cannot tolerate surgery due to their age or presence of comorbidities. Few studies have investigated efficacy and treatment outcomes for PMCT treatment in these patients, especially in China, where patients are more often diagnosed and treated early in life. This study evaluated the safety and efficacy of ultrasound-guided PMCT in treatment-naive elderly HCC patients, and analyzed risk factors associated with poor treatment outcomes.The 65 HCC patients in this retrospective study were divided into 2 groups: <65 years old or ≥65 years old. Patients received PMCT every month until tumor was unobservable and were then followed for 1 month after ablation. The primary clinical endpoint was the rate of complete tumor ablation, and secondary endpoints were progression-free survival and overall survival.Patients ≥65 years old had significantly poorer performance status than younger patients, but similar rates of complete ablation. Multiple tumors and hypertension were associated with a significantly higher risk of death, while higher postoperative alanine aminotransferase levels were associated with a significantly lower risk of death. Patients with tumor sizes >5 to ≤ 10 cm were at a significantly higher risk for disease progression than patients with tumor sizes >1 to ≤ 3 cm. Complete ablation significantly lowered the risk of disease progression.PMCT is safe and effective for patients ≥65 years of age, achieving total ablation in more than 90% of patients. Age and comorbidities did not affect clinical outcome.

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Thermal Ablation for Treating Malignant Tumors to the Liver

Mahnken

Baère

2018

Locoregional Tumor Therapy

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Therapeutic efficacy of percutaneous microwave coagulation versus liver resection for single hepatocellular carcinoma ≤3 cm with Child-Pugh A cirrhosis

Cited by 21 publications

References 37 publications

Microwave ablation compared with hepatic resection for the treatment of hepatocellular carcinoma and liver metastases: a systematic review and meta-analysis

Microwave ablation compared with hepatic resection for the treatment of hepatocellular carcinoma and liver metastases: a systematic review and meta-analysis

Clinical outcome in elderly Chinese patients with primary hepatocellular carcinoma treated with percutaneous microwave coagulation therapy (PMCT)

Thermal Ablation for Treating Malignant Tumors to the Liver

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