Efficacy and Safety of Microwave Ablation (MWA) for Hepatocellular Carcinoma (HCC) in Difficult Anatomical Sites in Egyptian Patients with Liver Cirrhosis

Ahmad F Soliman,Ahmed I Saleh,Nabil M El-Kady,Maha S Hasab Allah,Ehab H Elsayed,Haitham A Gabr,Wafaa M Ezzat,Amira Kamel,Mahmoud M Abouelkhair

doi:10.31557/apjcp.2019.20.1.295

Abstract

Background and aim:Imaging guided microwave ablation (MWA) for hepatocellular carcinoma (HCC) has become a widely used method over recent years. Tumors close to the diaphragm, gastrointestinal tract, gallbladder, pancreas, hepatic hilum and major bile duct or vessels are generally considered relative contraindications for microwave ablation. This study was conducted to assess the effectiveness and safety of ultrasonography-guided MWA in treating patients with HCC in difficult anatomical sites in comparison to those in conventional sites.Patients and methods:Eighty-eight patients were included and divided into two groups: the study group of 44 with 46 lesions lying <5mm from the diaphragm, hepatic capsule, gall bladder (GB) or large vessel; and the control group of 44 patients with 50 lesions in non-risky sites. Each lesion was ablated using an ultrasound guided microwave probe using a detailed protocol.Results:Most of the patients were males, with a mean age of 57.8 years. In the study group, two patients had lesions adjacent to the GB, twelve were perivascular and 32 were subcapsular. The overall successful ablation rates were 84.8% and 92% in the study and control groups, respectively. Within the study group, ablation rates were 100%, 75% and 87.5% for lesions close to the GB, perivascular lesions and subcapsular lesions, respectively. One patient developed a subcutaneous abscess, with good outcome after proper treatment. Fever, pain and asymptomatic pleural effusion were reported after ablation without statistically significant difference between the groups or among subgroups.In conclusion:MWA for HCC in difficult anatomical sites is as effective and safe as for ordinary sites.

Highlights

Hepatocellular carcinoma (HCC) accounts for nearly 90% of the primary liver tumors and is currently the third leading cause of cancer death worldwide (El-Serag, 2011)
Imaging-guided thermal ablation with use of different energy sources, such as radiofrequency (RF), microwave (MW), high intensity- focused ultrasound (HIFU), or laser has been used with different success rates
This study was started on 113 patients in Endemic Medicine department, Kasr Al-Ainy hospital (81 patients) and in hepatology unit of Arab contractors medical center (32 patients) in the period from January 2014 to June 2016, for patients having hepatocellular carcinoma that was diagnosed either by radiological, serological or histopathological methods,but the number included in our results were 88 patients (57 patients Kasr Al-Ainy hospital and 31 patients in hepatology unit of Arab contractors medical center) and 25 patients were excluded as they dropped during their follow up period

Summary

Introduction

Hepatocellular carcinoma (HCC) accounts for nearly 90% of the primary liver tumors and is currently the third leading cause of cancer death worldwide (El-Serag, 2011). Microwaves could offer more direct heating than other energies, making MW ablation (MWA) more potent in organs with high blood perfusion or near vascular heat sinks as compared with other thermo-ablative modalities, and the MWA zones are uniform in shape and size and remain unaffected by convective heat loss (Brace, 2010). These advantages made MWA a widely used method for treatment of hepatic tumors. In conclusion: MWA for HCC in difficult anatomical sites is as effective and safe as for ordinary sites

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