SAGES/AHPBA guidelines for the use of microwave and radiofrequency liver ablation for the surgical treatment of hepatocellular carcinoma or colorectal liver metastases less than 5 cm

Eugene P Ceppa¹, Amelia T Collings², Moustafa Abdalla³, Edwin Onkendi⁴, Daniel W Nelson⁵, Ahmad Ozair⁶, Emily Miraflor⁷, Faique Rahman⁸, Jake Whiteside⁹, Mihir M Shah¹⁰, Subhashini Ayloo¹¹, Rebecca Dirks⁹, Sunjay S Kumar¹², Mohammed T Ansari¹³, Iswanto Sucandy¹⁴, Kchaou Ali¹⁵, Sam Douglas¹⁶, Patricio M Polanco¹⁷, Timothy J Vreeland¹⁸, Joseph Buell¹⁹, Ahmed M Abou-Setta²⁰, Ziad Awad²¹, Choon Hyuck Kwon²², John B Martinie²³, Fabio Sbrana²⁴, Aurora Pryor²⁵, Bethany J Slater²⁶, William Richardson²⁷, Rohan Jeyarajah²⁸, Adnan Alseidi²⁹

Affiliations

¹ Department of Surgery, Indiana University School of Medicine, 545 Barnhill Dr, EH541, Indianapolis, IN, 46202, USA. eceppa@iu.edu.
² Hiram C. Polk, Jr. Department of Surgery, University of Louisville School of Medicine, Louisville, KY, USA.
³ Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
⁴ Department of Surgery, Texas Tech University Health Sciences Center, Lubbock, TX, USA.
⁵ Department of Surgery, William Beaumont Army Medical Center, El Paso, TX, USA.
⁶ King George's Medical University, Lucknow, India.
⁷ UCSF East Bay Department of Surgery, UCSF, Oakland, CA, USA.
⁸ Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, India.
⁹ Department of Surgery, Indiana University School of Medicine, 545 Barnhill Dr, EH541, Indianapolis, IN, 46202, USA.
¹⁰ Division of Surgical Oncology, Department of Surgery, Emory University Winship Cancer Institute, Atlanta, GA, USA.
¹¹ Department of Surgery, Brown University, Providence, RI, USA.
¹² Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
¹³ School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.
¹⁴ Digestive Health Institute, AdventHealth, Tampa, FL, USA.
¹⁵ Department of Surgery A, Sfax Medical School, Sfax, Tunisia.
¹⁶ Department of Surgery, Naval Medical Center Portsmouth, Portsmouth, VA, USA.
¹⁷ Division of Surgical Oncology, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA.
¹⁸ Department of Surgery, Brooke Army Medical Center, San Antonio, TX, USA.
¹⁹ Department of Surgery, Mission Health Care System, Asheville, NC, USA.
²⁰ University of Manibota, Winnepeg, Canada.
²¹ Department of Surgery, University of Florida, Jacksonville, FL, USA.
²² Department of General Surgery, Cleveland Clinic, Cleveland, OH, USA.
²³ Department of Surgery, Atrium Health, Charlotte, NC, USA.
²⁴ Department of Surgery, Chicago Medical School, Rosalind Franklin University, Chicago, IL, USA.
²⁵ Department of Surgery, Long Island Jewish Medical Center, Northwell Health, Great Neck, NY, USA.
²⁶ Department of Surgery, University of Chicago, Chicago, IL, USA.
²⁷ Department of Surgery, Ochsner Clinic, Jefferson, LA, USA.
²⁸ TCU/UNTHSC School of Medicine, Fort Worth, TX, USA.
²⁹ Department of Surgery, University of California, San Francisco, CA, USA.

PMID: 37957297
DOI: 10.1007/s00464-023-10468-1

SAGES/AHPBA guidelines for the use of microwave and radiofrequency liver ablation for the surgical treatment of hepatocellular carcinoma or colorectal liver metastases less than 5 cm

Eugene P Ceppa et al. Surg Endosc. 2023 Dec.

. 2023 Dec;37(12):8991-9000.

doi: 10.1007/s00464-023-10468-1. Epub 2023 Nov 13.

Authors

Affiliations

¹ Department of Surgery, Indiana University School of Medicine, 545 Barnhill Dr, EH541, Indianapolis, IN, 46202, USA. eceppa@iu.edu.
² Hiram C. Polk, Jr. Department of Surgery, University of Louisville School of Medicine, Louisville, KY, USA.
³ Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
⁴ Department of Surgery, Texas Tech University Health Sciences Center, Lubbock, TX, USA.
⁵ Department of Surgery, William Beaumont Army Medical Center, El Paso, TX, USA.
⁶ King George's Medical University, Lucknow, India.
⁷ UCSF East Bay Department of Surgery, UCSF, Oakland, CA, USA.
⁸ Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, India.
⁹ Department of Surgery, Indiana University School of Medicine, 545 Barnhill Dr, EH541, Indianapolis, IN, 46202, USA.
¹⁰ Division of Surgical Oncology, Department of Surgery, Emory University Winship Cancer Institute, Atlanta, GA, USA.
¹¹ Department of Surgery, Brown University, Providence, RI, USA.
¹² Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
¹³ School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.
¹⁴ Digestive Health Institute, AdventHealth, Tampa, FL, USA.
¹⁵ Department of Surgery A, Sfax Medical School, Sfax, Tunisia.
¹⁶ Department of Surgery, Naval Medical Center Portsmouth, Portsmouth, VA, USA.
¹⁷ Division of Surgical Oncology, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA.
¹⁸ Department of Surgery, Brooke Army Medical Center, San Antonio, TX, USA.
¹⁹ Department of Surgery, Mission Health Care System, Asheville, NC, USA.
²⁰ University of Manibota, Winnepeg, Canada.
²¹ Department of Surgery, University of Florida, Jacksonville, FL, USA.
²² Department of General Surgery, Cleveland Clinic, Cleveland, OH, USA.
²³ Department of Surgery, Atrium Health, Charlotte, NC, USA.
²⁴ Department of Surgery, Chicago Medical School, Rosalind Franklin University, Chicago, IL, USA.
²⁵ Department of Surgery, Long Island Jewish Medical Center, Northwell Health, Great Neck, NY, USA.
²⁶ Department of Surgery, University of Chicago, Chicago, IL, USA.
²⁷ Department of Surgery, Ochsner Clinic, Jefferson, LA, USA.
²⁸ TCU/UNTHSC School of Medicine, Fort Worth, TX, USA.
²⁹ Department of Surgery, University of California, San Francisco, CA, USA.

PMID: 37957297
DOI: 10.1007/s00464-023-10468-1

Abstract

Background: Primary hepatocellular carcinoma (HCC) and colorectal liver metastases (CRLM) represent the liver's two most common malignant neoplasms. Liver-directed therapies such as ablation have become part of multidisciplinary therapies despite a paucity of data. Therefore, an expert panel was convened to develop evidence-based recommendations regarding the use of microwave ablation (MWA) and radiofrequency ablation (RFA) for HCC or CRLM less than 5 cm in diameter in patients ineligible for other therapies.

Methods: A systematic review was conducted for six key questions (KQ) regarding MWA or RFA for solitary liver tumors in patients deemed poor candidates for first-line therapy. Subject experts used the GRADE methodology to formulate evidence-based recommendations and future research recommendations.

Results: The panel addressed six KQs pertaining to MWA vs. RFA outcomes and laparoscopic vs. percutaneous MWA. The available evidence was poor quality and individual studies included both HCC and CRLM. Therefore, the six KQs were condensed into two, recognizing that these were two disparate tumor groups and this grouping was somewhat arbitrary. With this significant limitation, the panel suggested that in appropriately selected patients, either MWA or RFA can be safe and feasible. However, this recommendation must be implemented cautiously when simultaneously considering patients with two disparate tumor biologies. The limited data suggested that laparoscopic MWA of anatomically more difficult tumors has a compensatory higher morbidity profile compared to percutaneous MWA, while achieving similar overall 1-year survival. Thus, either approach can be appropriate depending on patient-specific factors (very low certainty of evidence).

Conclusion: Given the weak evidence, these guidelines provide modest guidance regarding liver ablative therapies for HCC and CRLM. Liver ablation is just one component of a multimodal approach and its use is currently limited to a highly selected population. The quality of the existing data is very low and therefore limits the strength of the guidelines.

Keywords: Colorectal liver metastases; Guideline; Hepatocellular carcinoma; Liver tumor; Microwave ablation; Radiofrequency ablation.

PubMed Disclaimer

References

1. Ferlay J, Parkin DM, Curado MP et al (2014) Cancer incidence in five continents, volumes I to X: IARC CANCERBase No. 10. http://ci5.iarc.fr . Accessed 25 Nov 2014
1. Torre LA, Bray F, Siegel RL, Ferlay J, Lortet-Tieulent J, Jemal A (2015) Global cancer statistics, 2012. CA Cancer J Clin 65:87–108 - DOI - PubMed
1. Rich NE, Yopp AC, Singal AG, Murphy CC (2020) Hepatocellular carcinoma incidence is decreasing among younger adults in the United States. Clin Gastroenterol Hepatol 18(242–248):e245
1. Martin J, Petrillo A, Smyth EC, Shaida N, Khwaja S, Cheow H, Duckworth A, Heister P, Praseedom R, Jah A (2020) Colorectal liver metastases: Current management and future perspectives. World J Clin Oncol 11:761–808 - DOI - PMC
1. Siegel RL, Miller KD, Goding Sauer A, Fedewa SA, Butterly LF, Anderson JC, Cercek A, Smith RA, Jemal A (2020) Colorectal cancer statistics. CA Cancer J Clin 70:145–164 - DOI - PubMed

Publication types

Actions

MeSH terms

Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions

LinkOut - more resources

Full Text Sources
- Springer
Medical
- MedlinePlus Health Information

Save citation to file

Email citation

Add to Collections

Add to My Bibliography

Your saved search

Create a file for external citation management software

Your RSS Feed

SAGES/AHPBA guidelines for the use of microwave and radiofrequency liver ablation for the surgical treatment of hepatocellular carcinoma or colorectal liver metastases less than 5 cm

Affiliations

SAGES/AHPBA guidelines for the use of microwave and radiofrequency liver ablation for the surgical treatment of hepatocellular carcinoma or colorectal liver metastases less than 5 cm

Authors

Affiliations

Abstract

References

Publication types

MeSH terms

LinkOut - more resources

Full Text Sources

Medical