Ultrasound-guided percutaneous microwave ablation of hepatocellular carcinoma in challenging locations: oncologic outcomes and advanced assistive technology

Abstract

Purpose: To assess the oncologic outcomes of the hepatocellular carcinoma (HCC) patients in challenging locations (CLs) underwent ultrasound-guided percutaneous microwave ablation (US-PMWA) and the efficacy and safety of the advanced assistive technology (AAT). Materials and methods: Data for 489 treatment-naïve patients with HCC who met Milan criteria and subsequently underwent US-PMWA were reviewed from March 2012 to November 2016. According to the distance (<5 mm) between the tumor and surrounding structures, the patients were divided into two groups: a CL group and a non-CL group. Regarding MWA assisted by AAT, the CL group was further subdivided into two groups: an AAT group and a non-AAT group. Technique effectiveness, complications and survival outcomes (i.e., overall survival [OS] and recurrence-free survival [RFS]) were compared between CL and non-CL groups. Local tumor progression (LTP) was compared between AAT and non-AAT groups. Results: Technique effectiveness and complications in the CL group were similar to those in the non-CL group (p ¼ .873 and p ¼ .828, respectively). The OS and RFS in six types of CL groups were comparable with those in non-CL group (p ¼ .131-.117) including adjacent vital structures, gallbladder, hepatic hilar regions, major vessels, diaphragm and capsule, respectively. The LTP rates in the AAT group were significantly higher than those in the non-AAT group (p ¼ .001). Conclusions: US-PMWA assisted by AAT to treat HCC lesions in CLs was safe and effective; also, this technique had comparable success and survival outcomes with those of patients in non-CL.

Ultrasound-guided percutaneous microwave ablation for hepatocellular carcinoma adjacent to large vessels: a propensity score matching analysis

“…In addition, multiple nodules, large tumor size and high AFP level were risk factors for poor OS. This result suggested that the tumor characteristics play a key role in the prognosis of patients, which was consistent with previous studies [24,25]. At present, imaging technologies like CEUS, CT and MRI are most commonly used to evaluate the technical effectiveness of MWA [26].…”

“…percutaneous MWA for patients with HCC in challenging locations. The results also demonstrated that OS and RFS were not influenced by tumors whether near large vessels or not [24]. In multivariate analysis, recurrent type, multiple nodules, large tumor size and high GGT level were risk factors for poor RFS.…”

“…There are also concerns about the safety and complications of MWA for HCC adjacent to large vessels. With larger zones of necrosis, MWA may increase the risk of potential collateral injury to adjacent non-target organs such as gastrointestinal tract, diaphragm, gallbladder, etc [9,24,28]. Furthermore, the higher energy might cause injury to surrounding bile ducts and vessels, leading to cholangiectasis, bile leakage, thrombosis, occlusion of blood vessels and segmental liver infarction [8,11,24,29].…”

Capsule and Ablation Tract Related Features of Local Recurrence in Ultrasound Guided Microwave Ablation of Liver Metastases

“…In thermal ablation practice, especially with USguidance, both the subcapsular lesions and the sections of the lesion close to the liver capsule are sometimes disadvantageous places for the performer in terms of approaches and manipulations (21). The physicians usually prefer to use some assistive techniques such as hydrodissection to protect the liver capsule for an undesired and extrahepatic ablation (22).…”

<p>Computed Tomography-Guided Percutaneous Cryoablation for ‎ Subcardiac Hepatocellular Carcinoma: Safety, Efficacy, Therapeutic Results and Risk Factors for Survival Outcomes</p>

“…Therefore, a precise and cautious operation is essential to remove these tumours in challenging locations (eg, subcapsular and perivascular locations). 9,10 Cryoablation (CRA) has become one of the most effective locoregional therapies in HCC, presenting various advantages, [11][12][13] including the lack of serious damage to large blood vessels, the development of a visual ice ball activation of cryoimmunology in cancer and the absence of an association with severe pain. Most studies have reported that CRA has comparable outcomes to radiofrequency ablation (RFA) or microwave ablation (MWA) for HCC.…”