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Background
Hepatocellular carcinoma (HCC) is one of the most common malignancies and is the third cause of cancer-related death worldwide. Surgery is the optimal treatment for early HCC; however, the majority of cases are not suitable for curative resection at the time of diagnosis. Surgical resection difficulties may be related to size, site, numb...
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Simple Summary
Li-RADS classification has recently emerged as an accurate tool for hepatocellular carcinoma diagnosis in the setting of liver cirrhosis, but its prognostic value has never been investigated so far. Single HCC benefits from both surgical resection and percutaneous ablation, although several studies support the superiority of surgery...
Citations
... LAMWA was as effective and safe as Radio Frequency Ablation (RFA) in treating small HCC [11,12]. However, there are no studies comparing LAMWA and laparoscopic hepatectomy. ...
Laparoscopic-assisted microwave ablation (LAMWA), as one of the locoregional therapies, has been employed to treat hepatocellular carcinoma (HCC). This study aims to compare the efficacy and safety of LAMWA and laparoscopic hepatectomy in the treatment of small HCC.This study included 140 patients who met the inclusion criteria. Among them, 68 patients received LAMWA and 72 patients underwent laparoscopic hepatectomy. The perioperative condition, liver function recovery, the alpha fetoprotein (AFP) level, morbidities, hospitalization time, overall survival (OS), disease-free survival (DFS) and recurrence rate between the two groups were compared. The rate of complete elimination of tumor tissue was 100% and the AFP level was returned to normal within 3 months after surgery in both groups (P > 0.05). The mean alanine transaminase (ALT) and aspartate transaminase (AST) peak in the LAMWA group was lower than that in the laparoscopic hepatectomy group (259.51 ± 188.75 VS 388.9 ± 173.65, P = 0.000) and (267.34 ± 190.65 VS 393.1 ± 185.67, P = 0.000), respectively. The mean operation time in the LAMWA group was shorter than that in the laparoscopic hepatectomy group (89 ± 31 min VS 259 ± 48 min, P = 0.000). The blood loss in the LAMWA group was less than that in the laparoscopic hepatectomy group (58.4 ± 64.0 ml VS 213.0 ± 108.2 ml, P = 0.000). Compared with the laparoscopic hepatectomy group, patients in the LAMWA group had lower mean hospital stay (4.8 ± 1.2d VS 11.5 ± 2.9d, P = 0.000). The morbidities of the LAMWA group and the hepatectomy group were 14.7%(10/68) and 34.7%(25/72), respectively (P = 0.006). The one-, three-, and five-year OS rates were 88.2%, 69.9%, 45.6% for the LAMWA group and 86.1%, 72.9%, 51.4% for the laparoscopic hepatectomy group (P = 0.693). The corresponding DFS rates for the two groups were 76.3%, 48.1%, 27.9% and 73.2%, 56.7%, 32.0% (P = 0.958). Laparoscopic-assisted microwave ablation is a safe and effective therapeutic option for selected small HCC.
... In view of the disadvantages of the two aforementioned microwave ablation methods, laparoscopicassisted microwave ablation can partly compensate for theses disadvantages. A few reports have shown that LAMWA was as effective and safe as Radio Frequency Ablation (RFA) in treating small HCC [11,12] . ...
... in patients [20] . Potential therapies include percutaneous ethanol injection, cryotherapy, transarterial chemoembolization, transarterial radiotherapy, and laser ablation [11,19] . RFA has been widely applied because of safety, effectiveness, and minimal invasiveness [22,23] . ...
Laparoscopic-assisted microwave ablation (LAMWA), as one of the locoregional therapies, has been employed to treat hepatocellular carcinoma (HCC). This study aims to compare the efficacy and safety of LAMWA and laparoscopic hepatectomy in the treatment of small HCC.This study included 140 patients who met the inclusion criteria. Among them, 68 patients received LAMWA and 72 patients underwent laparoscopic hepatectomy. The perioperative condition, liver function recovery, the alpha fetoprotein (AFP) level, morbidities, hospitalization time, overall survival (OS), disease-free survival (DFS) and recurrence rate between the two groups were compared. The rate of complete elimination of tumor tissue was 100% and the AFP level was returned to normal within 3 months in both groups (P > 0.05). The mean alanine transaminase (ALT) and aspartate transaminase (AST) peak in the LAMWA group was lower than that in the laparoscopic hepatectomy group (259.51 SD 188.75 VS 388.9 SD 173.65, P = 0.000) and (267.34 SD 190.65 VS 393.1 SD 185.67, P = 0.000), respectively. The mean average operation time in the LAMWA group was shorter than that in the laparoscopic hepatectomy group (89 SD 31min VS 259 SD 48min, P = 0.000). The blood loss in the LAMWA group was less than that in the laparoscopic hepatectomy group (58.4 SD 64.0ml VS 213.0 SD 108.2ml, P = 0.000). Compared with the laparoscopic hepatectomy group, patients in the LAMWA group had few periods of hospital stay (4.8 SD 1.2d VS 11.5 SD 2.9d, P = 0.000). The morbidities of the LAMWA group and the hepatectomy group were 14.7%(10/68) and 34.7༅(25/72), respectively (P = 0.006)༎The 1-, 3-, and 5-year OS rates were 88.2%, 69.9%, 45.6% for the LAMWA group and 86.1%, 72.9%, 51.4% for the laparoscopic hepatectomy group (P = 0.693). The corresponding DFS rates for the two groups were 76.3%, 48.1%, 27.9% and 73.2%, 56.7%, 32.0% (P = 0.958). Laparoscopic-assisted microwave ablation is a safe and effective therapeutic option for selected small HCC.
... Primary liver cancer is one of the most common cancers in China [1], ranking fourth in incidence and third in mortality rate [2]. Surgical resection remains the preferred treatment for liver cancer [3], but some patients are not candidates for hepatectomy due to cirrhosis, hepatic insufficiency, or poor general health. ...
Background
The aim of this study was to assess the effect of indocyanine green (ICG) fluorescence imaging combined with laparoscopic ultrasound in laparoscopic microwave ablation of liver cancer.
Material/Methods
This study retrospectively analyzed 61 patients who underwent laparoscopic microwave ablation of liver cancer, including laparoscopic microwave ablation with and without ICG fluoroscopy.
Results
The operative times, ablation times, postoperative hospital stay, postoperative complication rate, hospitalization cost, postoperative liver function changes, and postoperative overall survival were similar between the 2 groups, but there was a statistically significant difference in recurrence-free survival (P<0.05). A total of 5 lesions were found in the fluorescence laparoscopy group that were not found by preoperative imaging, while no new lesions were found in the ordinary laparoscopy group. Fluorescence laparoscopy has obvious advantages over ordinary laparoscopy in finding small lesions that were not found before surgery. In terms of complete ablation rate, 3 patients in the ordinary laparoscopy group and 1 patient in the fluorescence laparoscopy group were judged to be incompletely ablated and were ablated again at 1 month after the operation.
Conclusions
For small hepatocellular carcinoma with severe liver cirrhosis and located on the liver surface, fluorescence laparoscopy can better reveal the location and boundary of the tumor, and fluorescence laparoscopy can detect tiny lesions that cannot be detected by preoperative imaging. The combination of fluorescence laparoscopy and microwave ablation has a good effect on the treatment of small hepatocellular carcinoma located on the surface of the liver that is difficult to distinguish.
... A major advantage of laparoscopy is the ability to ablate tumors that cannot be safely treated by a percutaneous approach (e.g., superior-posterior tumors or those near perihepatic viscera), allowing for ablation of more tumors. Exophytic tumors are common, with the frequency of these tumors ranging from 16 to 52% of all HCC tumors in previous studies [22]. Traditionally, ablation of exophytic and subcapsular tumors have been considered contraindications to thermal ablation because of the reported increased risk of tumor seeding, tumor recurrence, and incomplete ablation [14,15]. ...
Background
Laparoscopic-assisted thermal ablation has been used successfully to treat early hepatocellular carcinoma (HCC) tumors, defined as < 3 cm in diameter. This approach allows for ablation of tumors located in areas of the liver that are otherwise inaccessible for a percutaneous approach. Thermal ablation of exophytic tumors remains controversial due to a reported increased risk of tumor seeding of the abdominal cavity and incomplete ablation.
Methods
This cohort study consisted of 663 HCC tumors treated with thermal ablation at a single, quaternary academic medical center between 2/2001 and 1/2021. Post treatment, patients were followed at a defined interval schedule beginning at one month post treatment, then every 3 months for 2 years, every 6 months in year 3, followed by yearly studies. Patients’ medical records were reviewed for three years post ablation for evidence of complete ablation and intra-abdominal dissemination of disease.
Results
326 patient records met the inclusion criteria. Comparing the exophytic and non-exophytic groups, there were statistically significant differences in etiology of liver disease (p = 0.048) and TNM stage (p = 0.03), as well as a higher rate of incomplete ablation in the non-exophytic group (10.2% vs 3.3%; p = 0.045). Otherwise, there were no statistically significant differences in baseline characteristics, tumor characteristics, or use of thermal ablation technology. Rates of intra-abdominal dissemination of HCC were low in both groups: 1.1% (n = 1) in the exophytic group and 1.7% (n = 4) in the non-exophytic group. There was no significant difference in intra-abdominal dissemination of HCC between the groups (p > 0.99, RR = 0.66; 95% CI 0.07–5.79). Additionally, no differences were seen in dissemination between microwave ablation and radiofrequency ablation (p > 0.99).
Conclusion
This study demonstrates that laparoscopic-assisted thermal ablation of small, exophytic tumors is safe and does not increase the risk for disseminated intra-abdominal HCC disease.
Background:
At present, there are still disputes on the treatment of surgery for patients with stage B hepatocellular carcinoma (HCC). This study sought to investigate whether the up-to-7 criterion could be used to decide the treatment for HCC in Barcelona Clinic Liver Cancer stage B (BCLC-B).
Methods:
We analyzed 340 patients with HCC in BCLC-B who treated with hepatectomy or transcatheter arterial chemoembolization (TACE). Of the 285 HCC patients who underwent hepatectomy, 108 met the up-to-7 criterion and 177 exceeded it. All 55 patients in the TACE group met the up-to-7 criterion. We obtained the tumor status of the patients through inpatient medical records, outpatient medical records, and telephone follow-up of the hospital. We compared overall survival (OS) and progression-free survival (PFS) were compared between patients who met the up-to-7 criterion and who underwent either hepatectomy or TACE. OS and recurrence time were also compared between the patients who were treated with hepatectomy and who either met or exceeded the up-to-7 criterion. Across BCLC-B patients, we compared the OS of patients after surgical treatment between subgroups stratified by tumor number and diameter.
Results:
Patients who met the up-to-7 criterion had significantly higher OS rates after hepatectomy than TACE (P<0.001). However, the 2 groups did not differ in terms of PFS (P=0.758). Among the patients treated by hepatectomy, the OS rates were significantly higher in patients who met the up-to-7 criterion than in those who exceeded it (P=0.001). The recurrence rates did not differ between patients who met or exceeded the criterion (P=0.662). OS was significantly higher in patients with ≤3 tumors than those with >3 tumors (P=0.001). When we stratified patients with ≤3 tumors based in whether they met or exceeded the up-to-8 to up-to-15 criterion, OS was significantly better among those who met the criterion in all cases.
Conclusions:
Hepatectomy appears to be associated with better survival than TACE in patients with BCLC-B HCC who meet the up-to-7 criterion, but this criterion is not a strict indication for deciding whether to treat patients with BCLC-B surgically. Tumor number strongly affects the prognosis of BCLC-B patients after hepatectomy.
Background
Microwave ablation (MWA) has become the standard thermal-based treatment for hepatic malignancies in patients who have unresectable disease based on the biology of the tumor, the patients’ comorbidities, and certain disease sites. The technical effectiveness, ablation success, local recurrence rates of hepatic malignancies treated with the various commercial microwave ablation devices has not been previously published in the peer reviewed literature. The aim of this systematic review is to summarize the clinical outcomes for the various MWA devices in the use of a hepatic malignancies to best educate hepatic surgeons as well as interventional radiologists.
Methods
A comprehensive review of the literature and instructions for use of each device that was published from 1/2013 to 12/2020 was performed. The main outcomes extracted were technical success, ablation success, major complications, local and new recurrence rates, recurrence-free survival, ablation volumes, time, and the number of antennas required. A qualitative review of the literature was performed.
Results
In total, 29 studies reporting data on 3250 patients and 4500 tumors were included in this review. Median patient age was 60.5 years (range 3–91). 76.3% (2420 M/753 F) of patients were male. Hepatocellular carcinoma (55%) was the most common tumor pathology followed by colorectal liver metastasis (10%) and cholangiocarcinoma (4%). A majority of studies reported technical success (range, 91.6–100%) and ablation success (range, 73.1–100%), as well as major complications (range, 0–9.1%). Local recurrence (range, 0–50%) was reported by 21 of the studies; however, new recurrence (range, 12.2–64%) was reported less frequently (6 studies) and were further specified in 12, six, and four studies as intrahepatic distant recurrence (11.3–54.2%), extrahepatic distant recurrence (3.6–20%), and metastasis (1.1–36%). A total of three, six, and five studies report disease, progression, and recurrence-free survival rates, respectively.
Conclusion
Microwave ablation is frequently used for the treatment of hepatic malignancies. A thorough understanding of the clinical outcomes associated with different pathologies and MWA devices can improve surgeon awareness and help prepare for operative planning and patient management. More consistent reporting of key outcomes in the literature is needed to achieve such an understanding.
