Laparoscopic Assisted Percutaneous Microwave Ablation for Hepatocellular Carcinoma Close to Large Hepatic Vessels

Abstract

Background: Hepatocellular carcinoma (HCC) is one of the most common cancers worldwide. It was believed that ablation for tumors close to large vessels should be avoided for the concern of major complications. Microwave ablation (MWA) seemed to be a better choice than radiofrequency ablation (RFA) in treating HCC close to large vessels (≥ 3 mm), for its advantages of a lower susceptibility to heat-sink effects (blood-vessel-mediated cooling), as well as the ability to achieve larger tumor volumes in shorter time. The aim of this study is to evaluate safety and efficacy of MWA for HCC close to large vessels. Methods: 32 patients with 52 HCC lesions were included, all patients have a lesion close to large vessel. 14 patients had single lesion, 16 had two lesions and 2 had three lesions. All patients are Child-Pugh A or B within Milan Criteria and class A disease Barcelona Clinic Liver Cancer (BCLC). Results: This study was conducted on 32 HCC patients 24 males and 8 females with median age 63 years. 32 HCC lesions were close to large vessel while 20 lesions were not close to large vessel. Laparoscopic assisted percutaneous MWA was decided as the treatment of choice for all patients. two patients (6%) had major complications (one patient had right portal vein thrombosis and the other patient had intra-hepatic hematoma), 3 patients (9%) had minor complications in the form of skin burn. Local tumor progression (LTP) occurred in 2 lesions (3.8% of lesions). Conclusion: laparoscopic assisted percutaneous MWA proved to be a safe and effective as a management for HCC close to large vessels.