Hepatectomy with Concomitant Ablation: Comparison of Radiofrequency and Microwave Techniques

Abstract

Introduction: Hepatectomy with concomitant ablation expands the pool of patients who otherwise would be relegated to systemic chemotherapy alone. While radiofrequency ablation (RFA) has been utilized most often, microwave ablation (MA) has gained popularity. The aims of this study were to compare utilization over time and outcomes of RFA and MA in North American patients undergoing hepatectomy. Methods: Patients undergoing hepatectomy with concomitant ablation were identified in the 2014-17 ACS-NSQIP procedure targeted database. Patients having concomitant biliary-enteric anastomoses or colectomy were excluded. Patients having RFA or MA were compared over time by control charts. RFA and MA patients were propensity score matched based on their age, race, disseminated cancer, operative approach, hepatectomy extent and perioperative transfusions. Outcomes were compared by standard statistical tests. Results: Of 1,589 patients undergoing concomitant hepatectomy and ablation, 964 (60%) had RFA and 635 (40%) received MA. Control chart analysis over 16 quarters demonstrated no change in the frequency of RFA (mean 60 procedures/quarter). In comparison, the quarterly frequency of MA increased from 21 to 79 (p< 0.05). After matching, RFA and MA patients had similar mortality, serious morbidity, bile leaks, post hepatectomy liver failure, organ space infections, reoperations and length of stay. However, MA was associated with lower rates of deep vein thrombosis (DVT) and sepsis (each p< 0.05).Table.Comparison of Outcomes in Hepatectopmy Patients Undergoing Concomitant RFA and MAOutcomeRFA (n=549)MA (n=549)p-valueMortality (%)0.70.40.41Serious Morbidity (%)13.112.90.93Bile Leak (%)4.65.10.66Post-Hepatectomy Liver Failure B/C (%)1.30.70.36Organ Space Infection (%)5.64.00.21Deep Venous Thrombosis (%)1.80.50.05Sepsis (%)3.81.30.01Reoperation (%)2.22.60.69Length of Stay (days)550.39 Open table in a new tab Conclusions: In recent years, MA is being utilized more frequently in patients undergoing hepatectomy while concomitant RFA rates have not changed. MA is associated with fewer postoperative DVTs and lower rates of procedure related sepsis.