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. 2023 Mar 25;15(7):1965.
doi: 10.3390/cancers15071965.

Patient Selection and Outcomes of Laparoscopic Microwave Ablation of Hepatocellular Carcinoma

Robert C G Martin 2nd  1 , Matthew Woeste  1 , Michael E Egger  1 , Charles R Scoggins  1 , Kelly M McMasters  1 , Prejesh Philips  1
Affiliations

Patient Selection and Outcomes of Laparoscopic Microwave Ablation of Hepatocellular Carcinoma

Robert C G Martin 2nd et al. Cancers (Basel). .

Abstract

Background: Laparoscopic microwave ablation (MWA) of hepatocellular carcinoma is underutilized and predictors of survival in this setting are not well characterized.

Methods: The prognostic value of clinicopathologic variables was evaluated on progression-free survival (PFS) and overall survival (OS) by univariate and multivariate analyses. The aim of this study was to evaluate a preferred laparoscopic MWA approach in HCC patients that are not candidates for percutaneous ablation and further classify clinicopathologic factors that may predict survival outcomes following operative MWA in the setting of primary HCC.

Results: 184 patients with HCC (median age 66, (33-86), 70% male) underwent laparoscopic MWA (N = 162, 88% laparoscopic) compared to 12% undergoing open MWA (N = 22). Median PFS was 29.3 months (0.2-170) and OS was 44.2 months (2.8-170). Ablation success was confirmed in 100% of patients. Ablation recurrence occurred in 3% (6/184), and local/hepatic recurrence occurred in 34%, at a median time of 19 months (9-18). Distant progression was noted in 8%. Median follow up was 34.1 months (6.4-170). Procedure-related complications were recorded in six (9%) patients with one 90-day mortality. Further, >1 lesion, AFP levels ≥ 80 ng/mL, and an "invader" on pre-operative radiology were associated with increased risk of progression (>1 lesion HR 2.92, 95% CI 1.06 -7.99, p = 0.04, AFP ≥ 80 ng/mL HR 4.16, 95% CI 1.71-10.15, p = 0.002, Invader HR 3.16, 95% CI 1.91-9.15, p = 0.002 ) and mortality (>1 lesion HR 3.62, 95% CI 1.21-10.81, p = 0.02], AFP ≥ 80 ng/mL HR 2.87, 95% CI 1.12-7.35, p = 0.01, Invader HR 3.32, 95% CI 1.21-9.81, p = 0.02).

Conclusions: Preoperative lesion number, AFP ≥ 80 ng/mL, and an aggressive imaging characteristic (Invader) independently predict PFS and OS following laparoscopic operative MWA.

Keywords: hepatocellular carcinoma; liver; microwave ablation; thermal ablation.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
(a) Progression free survival and (b) overall survival of study cohort. All 184 patients were followed for PFS as presented (a) and OS as in (b).
Figure 2
Figure 2
Graded method for educating laparoscopic ablation and ultrasound skill.
See this image and copyright information in PMC

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