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Observational Study
. 2025 Feb;32(2):1063-1072.
doi: 10.1245/s10434-024-16462-8. Epub 2024 Dec 10.

Hierarchically Positioning Laparoscopic Microwave Ablation in the Therapeutic Span of Early Hepatocellular Carcinoma: A Real-Life Comparative Analysis

Umberto Cillo  1 , Silvia Caregari  2 , Matteo Barabino  3 , Ilaria Billato  2 , Andrea Marchini  2 , Alessandro Furlanetto  2 , Sara Lazzari  2 , Marco Brolese  2 , Mattia Ballo  2 , Elisabetta Biasini  4 , Ciro Celsa  5 , Angelo Sangiovanni  6 , Francesco Giuseppe Foschi  7 , Claudia Campani  8 , Gianpaolo Vidili  9 , Carlo Saitta  10 , Fabio Piscaglia  11 , Maurizia Rossana Brunetto  12 , Alberto Masotto  13 , Fabio Farinati  14 , Franco Trevisani  15 , Marco Antonio Zappa  16 , Alessandro Vitale  2 , Roberto Santambrogio  17 ; ITA.LI.CA Study Group
Collaborators, Affiliations
Observational Study

Hierarchically Positioning Laparoscopic Microwave Ablation in the Therapeutic Span of Early Hepatocellular Carcinoma: A Real-Life Comparative Analysis

Umberto Cillo et al. Ann Surg Oncol. 2025 Feb.

Abstract

Background: Laparoscopic microwave ablation (LMWA) has yet to gain a specific place in treatment guidelines for early hepatocellular carcinoma (HCC). This study compared the outcomes of LMWA and trans-arterial chemoembolization (TACE) for early non-resectable patients with HCC, taking percutaneous radiofrequency ablation (PRFA) as the reference treatment.

Methods: A retrospective multicenter observational study was conducted, enrolling non-transplantable, non-resectable patients who had early HCC treated with LMWA (n = 658) from Padua and Milan centers, and with PRFA (n = 844), and TACE (n = 425) from the ITA.LI.CA multicenter database. The matching-adjusted indirect comparison (MAIC) method was used to obtain weighted LMWA and TACE populations similar to the reference PRFA population.

Results: Laparoscopic ablation showed an excellent safety profile, and MAIC-weighted early postoperative deaths were comparable among the groups. The MAIC-weighted overall survival was similar between the LMWA (1-, 3-, and 5 year survival of 91.0 %, 67.9 %, 47.0 %, respectively) and PRFA (1-, 3- and 5 year survivals of 90.0 %, 64.7 %, 46.6 %, respectively) groups (p = 0.678) and significantly better for the LMWA group than for the TACE group (1-, 3- and 5 year survivals of 84.7 %, 48.8 %, 33.6 %, respectively) (p < 0.001). Weighted multivariate overall survival analysis and competing risk/subgroup analyses confirmed the non-inferiority of LMWA to PRFA and its superiority to TACE. The LMWA- and PRFA-treated patients had a significantly lower risk of HCC-related death (p = 0.004) than the TACE-treated patients (p = 0.001). Conversely, the groups did not differ significantly in terms of non-HCC-related deaths.

Conclusions: The non-inferiority of LMWA to PRFA, its superiority to TACE, and its applicability to a wide range of presentations with few contraindications support its inclusion among radical therapies for treating early-HCC patients.

Keywords: Ablation techniques; Carcinoma; Chemoembolization; Hepatocellular; Laparoscopy; Liver cirrhosis; Therapeutic.

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Conflict of interest statement

Disclosure: Fabio Piscaglia received honoraria for serving on advisory boards, speaking at symposia from Astrazeneca, Bayer, Bracco, ESAOTE, EISAI, Exact Sciences, GE, Gilead, IPSEN, MSD, Nerviano, Roche, Samsung, and Siemens Healthineers, Maurizia Brunetto, and serving on the advisory boards of Gilead and Roche as well as the speakers’ bureau of AbbVie, Gilead, EISAI-MSD, AstraZeneca Franco Trevisani-AbbVie, Astra Zeneca, Bayer, Gilead, EISAI, and MSD.

References

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