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. 2024 Oct;38(10):5785-5792.
doi: 10.1007/s00464-024-11125-x. Epub 2024 Aug 15.

Laparoscopic ablation for liver malignancies: initial experience at a Scandinavian high volume HPB center

Jeanett Klubien  1   2 , Lucas Alexander Knøfler  1   2 , Peter Nørgaard Larsen  1 , Susanne Dam Nielsen  1   3   4 , Daisuke Fukumori  1 , Jens Georg Hillingsø  1 , Christoph Tschuor #  1   4 , Hans-Christian Pommergaard #  5   6   7   8
Affiliations

Laparoscopic ablation for liver malignancies: initial experience at a Scandinavian high volume HPB center

Jeanett Klubien et al. Surg Endosc. 2024 Oct.

Abstract

Background: Ablation is an effective, parenchymal-sparing treatment for primary liver cancer and liver metastases. The purpose of this study was to report our initial experience with laparoscopic microwave ablation regarding postoperative complications, rate of conversions to open procedure, and technical efficacy.

Methods: This was a quality improvement project carried out at a tertiary care center in Denmark. Patients ≥ 18 years old with liver malignancies, not available for percutaneous ablation, and treated with ultrasound-guided laparoscopic ablation were included.

Results: From March 2023 to December 2023, 39 patients were referred for laparoscopic ablation after a multidisciplinary team conference. Of these, two procedures were converted to open procedures due to adhesion and tumor progression. Three patients rejected the sharing of medical information, two procedures were canceled and in one case the strategy was changed perioperatively. Therefore, 32 procedures in 31 patients were available for analysis. Complete ablation was evaluated after 1 month and was achieved in 100% of the procedures. None of the patients died, and no complications were reported in 21 cases (65.6%). Most patients with complications had a grade 1 complication based on the Clavien-Dindo classification, which among others included abdominal and shoulder pain, atrial fibrillation, and subcutaneous hematoma. Two patients had a complication grade 2 (wound infection and decompensated cirrhosis) and one had a grade 4b (sepsis due to pneumonia and urinary tract infection). The median Comprehensive Complication Index was 12.2 (interquartile range 8.7-24.2). Furthermore, univariable logistic regression showed that ≥ 2 tumors treated were associated with a higher risk of complications (odds ratio 6.37, 95% confidence interval [1.20;33.85], p-value = 0.0297).

Conclusion: Ultrasound-guided laparoscopic microwave ablation of liver malignancies is feasible and safe with little risk for complications, a high technical efficacy, and a low rate of conversions to open procedures.

Keywords: Laparoscopic ablation; Liver malignancies; Liver tumors; Microwave ablation.

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Conflict of interest statement

Jeanett Klubien, Peter Nørgaard Larsen, Daisuke Fukumori, and Christoph Tschuor have no conflict of interest or financial ties to disclose. Susanne Dam Poulsen received grants from Novo Nordisk Foundation, Independent Research Fund, and Svend Andersen Foundation not related to this work. Lucas Alexander Knøfler and Hans-Christian Pommergaard received grants from Danish Cancer Society, and Hans-Christian Pommergaard further received from the Independent Research Fund, the Research Foundation of Rigshospitalet, and Svend Andersen Foundation not related to this work. Susanne Dam Poulsen has received consulting fees from Gilead, MSD, and Takeda and honoraria from Gilead and Takeda. Jens Georg Hillingsø received teaching honoraria from Novo Nordisk and Pharmacosmos. Hans-Christian Pommergaard participate on the board of Astra Zenica and Susanne Dam Poulsen of Gilead, MSD, and Takeda.

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