Comparative study evaluating pain after hepatectomy versus percutaneous microwave ablation in hepatocellular carcinoma patients: retrospective analysis of a single center’s experience

Abstract

Purpose: To compare post-therapeutic pain and analgesia following surgical hepatectomy versus image-guided percutaneous microwave ablation (MWA) for the treatment of hepatocellular carcinoma (HCC). Material and Methods: This is a retrospective, single-cener, study of 64 consecutive patients with HCC, who underwent either partial hepatectomy (Group A: 32 patients) or image-guided MWA (Group B: 32 patients) between January 2015 and January 2017. In Group B, MWA was performed under local anaesthesia and conscious sedation. The study’s primary outcome measure was the comparison of daily pain score between the two groups, using a self-reported Numeric Visual Scale (NVS) questionnaire. Secondary outcome measure included the comparison of required analgesics (type and dose) administrated. Pain score comparison between the two groups was performed with independent samples Mann-Whitney U test. Results: Mean pain score was significantly lower each day for Group B compared to Group A (NVS units: 1.82 ± 1.88 vs. 7.67 ± 0.88 in day 1; 0.64 ± 0.84 vs. 7.43 ± 0.93 in day 2, 0 vs. 6.97 ± 1.12 in day 3 and 0 vs. 6.35 ± 1.08 in day 4; p<0.001, respectively). In Group A, 13/32 patients (40.6%) required patient controlled analgesia (PCA) using intravenous infusion pump and 19/32 patients (59.4%) underwent epidural catheter placement. In Group B, 4/32 patients (12.5%) required minor analgesia (single intravenous dose of paracetamol) only during the first day. Conclusions: According to the self reported pain scores, image-guided percutaneous MWA resulted in significantly less pain during the follow-up period compared to partial hepatectomy, without the need of epidural or intravenous pump analgesia.