Abstract
BackgroundPercutaneous magnetic resonance-guided (MR-guided) MWA procedures have traditionally been performed under local anesthesia (LA) and sedation. However, pain control is often difficult to manage, especially in some cases when the tumor is large or in a specific location, such as near the abdominal wall or close to the hepatic dome. This study retrospectively compared the results of general anesthesia (GA) and local anesthesia (LA) for MR-guided microwave ablation (MWA) in patients with hepatocellular carcinoma (HCC ≤ 5.0 cm) to investigate whether different anesthesia methods lead to different clinical outcomes.MethodsThe results of the analysis include procedure-related complications, imaging response, and the time to complete two sets of procedures. According to the type of anesthesia, the Kaplan-Meier method was used to compare the local tumor progression (LTP) of the two groups who underwent MR-guided MWA.ResultsAll patients achieved technical success. The mean ablation duration of each patient in the GA group and LA group was remarkably different (P = 0.012). Both groups had no difference in complications or LTP (both P > 0.05). Notably, the tumor location (challenging locations) and the number of lesions (2–3 lesions) could be the main factors affecting LTP (p = 0.000, p = 0.015). Univariate Cox proportional hazard regression indicated that using different anesthesia methods (GA and LA) was not associated with longer LTP (P = 0.237), while tumor location (challenging locations) and the number of lesions (2–3 lesions) were both related to shorter LTP (P = 0.000, P = 0.020, respectively). Additionally, multivariate Cox regression further revealed that the tumor location (regular locations) and the number of lesions (single) could independently predict better LTP (P = 0.000, P = 0.005, respectively).ConclusionsNo correlation was observed between GA and LA for LTP after MR-guided MWA. However, tumors in challenging locations and the number of lesions (2–3 lesions) appear to be the main factors affecting LTP.
Highlights
Percutaneous magnetic resonance-guided (MR-guided) microwave ablation (MWA) procedures have traditionally been performed under local anesthesia (LA) and sedation
This study explored the relationship between anesthesia techniques (GA and LA) and local tumor progression and attempted to establish a regression model to further determine the effect of general anesthesia (GA) on tumor prognosis
Univariate Cox proportional hazard regression indicated that using different anesthesia methods (GA and LA) was not associated with longer local tumor progression (LTP) (P = 0.237), while tumor location and the number of lesions (2–3 lesions) were all related to shorter LTP
Summary
Percutaneous magnetic resonance-guided (MR-guided) MWA procedures have traditionally been performed under local anesthesia (LA) and sedation. This study retrospectively compared the results of general anesthesia (GA) and local anesthesia (LA) for MR-guided microwave ablation (MWA) in patients with hepatocellular carcinoma (HCC ≤ 5.0 cm) to investigate whether different anesthesia methods lead to different clinical outcomes. Until a few decades ago, surgical resection was the only effective choice for the treatment of hepatocellular carcinoma (HCC). Ablation has been established as the standard treatment for small HCC and has shown the same oncological results as surgical resection in randomized studies [3,4,5]. Studies have shown that the choice of anesthesia may affect the clinical prognosis of patients with malignant tumors [10]. Tumor recurrence involves many causes, and anesthesia methods and anesthetics have recently attracted widespread attention [11, 12]
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