MR-guided microwave ablation of hepatocellular carcinoma (HCC): is general anesthesia more effective than local anesthesia?

Abstract

Background: Percutaneous magnetic resonance-guided (MR-guided) MWA procedures have traditionally been performed under local anesthesia (LA) and sedation. However, pain control is often difficult to manage, especially in some cases when the tumor is large or in a specific location, such as near the abdominal wall or close to the hepatic dome. This study retrospectively compared the results of general anesthesia (GA) and local anesthesia (LA) for MR-guided microwave ablation (MWA) in patients with hepatocellular carcinoma (HCC ≤ 5.0 cm) to investigate whether different anesthesia methods lead to different clinical outcomes.

Methods: The results of the analysis include procedure-related complications, imaging response, and the time to complete two sets of procedures. According to the type of anesthesia, the Kaplan-Meier method was used to compare the local tumor progression (LTP) of the two groups who underwent MR-guided MWA.

Results: All patients achieved technical success. The mean ablation duration of each patient in the GA group and LA group was remarkably different (P = 0.012). Both groups had no difference in complications or LTP (both P > 0.05). Notably, the tumor location (challenging locations) and the number of lesions (2-3 lesions) could be the main factors affecting LTP (p = 0.000, p = 0.015). Univariate Cox proportional hazard regression indicated that using different anesthesia methods (GA and LA) was not associated with longer LTP (P = 0.237), while tumor location (challenging locations) and the number of lesions (2-3 lesions) were both related to shorter LTP (P = 0.000, P = 0.020, respectively). Additionally, multivariate Cox regression further revealed that the tumor location (regular locations) and the number of lesions (single) could independently predict better LTP (P = 0.000, P = 0.005, respectively).

Conclusions: No correlation was observed between GA and LA for LTP after MR-guided MWA. However, tumors in challenging locations and the number of lesions (2-3 lesions) appear to be the main factors affecting LTP.

Keywords: Hepatocellular carcinoma; Interventional radiology; Magnetic resonance imaging; Microwave ablation.

Fig. 1

Magnetic resonance imaging and placement of anesthesia equipment during treatment

Fig. 2

A patient completed MR-guided MWA treatment under general anesthesia. a-b The liver caudate lobe (red arrow) has a diameter of 17 mm and appears as hyper-intensity on T2-weighted transverse images before MWA. c-e The trajectory of the tilting puncture were adjusted gradually for the lesion target under the guidance of T1WI and the image shows precise insertion of the antenna into the target. f After 1 day of MWA, magnetic resonance reexamination found the treatment border covered the lesion completely as hyperintensity on T1WI (dashed circle). g Follow-up for 1 month, the lesion (red arrow) was completely ablated

Fig. 3

a. Comparison of local tumor progression (LTP) after ablation under local anesthesia (LA) and general anesthesia (GA). The mean LTP was 33.434 months (95% CI: 31.133, 35.734) in GA versus 31.132 months (95% CI: 28.535, 33.730) in LA (p = 0.230, log-rank test). The 12-, 24-, and 36-month LTP rates in GA were 94.1, 87.9 and 74.4%, respectively, and the 12-, 24-, and 36-month LTP rates in LA were 94.7,84.2 and 62.1%, respectively. b. Comparison of different anesthesia methods on LTP of tumor in challenging locations. The mean LTP was 32.055 months (95% CI: 28.973, 35.138) in GA versus 26.551 months (95% CI: 22.049, 31.053) in LA (p = 0.180, log-rank test). The 12-, 24-, and 36-month LTP rates in GA were 100.0, 76.0 and 48.4%, respectively, and the 12-, 24-, and 36-month LTP rates in LA were 88.9,66.7 and 35.4%, respectively.(Note: challenging locations--Hepatic dome, close to the heart/diaphragm/hepatic hilum)

Fig. 4

a. Comparison of local tumor progression (LTP) between tumor in regular locations and challenging locations after MR-guided MWA treatment. The mean LTP was 35.533 months (95% CI:34.903, 36.162) in regular locations versus 28.607 months (95% CI: 25.423, 31.792) in challenging locations (p = 0.000, log-rank test). The 12-, 24-, and 36-month LTP rates in tumor with regular locations were 100.0, 100.0 and 91.6%, respectively, and the12-, 24-, and 36-month LTP rates in tumor with challenging locations were 88.6,71.2 and 40.2%, respectively; b. Comparison of local tumor progression (LTP) between single tumors and multiple tumors (2–3 lesions) after MR-guided MWA treatment. The mean LTP was 33.111 months (95% CI: 31.147, 35.075) for procedures with a single lesion versus 30.424 months (95% CI: 26.992, 33.855) for procedures with 2–3 lesions (p = 0.015, log-rank test). The 12-, 24-, and 36-month LTP-free survival rates in patients with a single lesion were 97.9, 87.0 and 77.8%, respectively, and the 12-, 24-, and 36-month LTP-free survival rates in patients with 2–3 lesions were 88.0,84.0 and 47.6%, respectively. (Note: challenging locations--Hepatic dome, close to the heart/diaphragm/hepatic hilum)