Skip to main content
Erschienen in: Annals of Surgical Oncology 1/2017

31.08.2016 | Hepatobiliary Tumors

Comparison of Laparoscopic Microwave to Radiofrequency Ablation of Small Hepatocellular Carcinoma (≤3 cm)

verfasst von: Roberto Santambrogio, MD, Jason Chiang, MD, PhD, Matteo Barabino, MD, Franca Maria Meloni, MD, Emanuela Bertolini, MD, Fabio Melchiorre, MD, Enrico Opocher, MD

Erschienen in: Annals of Surgical Oncology | Ausgabe 1/2017

Einloggen, um Zugang zu erhalten

Abstract

Background

Laparoscopic thermal ablation is a common alternative to surgical resection in treating hepatic tumors, particularly in those located in difficult-to-reach locations.

Objective

The aim of this study was to compare the safety and long-term efficacy of laparoscopic radiofrequency ablation (RFA) and microwave ablation (MWA) in treating hepatocellular carcinoma (HCC).

Method

From February 2009 to May 2015, data from patients with HCC nodules who had undergone either laparoscopic MWA or laparoscopic RFA were examined. Complications, complete ablation rates, local tumor progression (LTP) rates, and disease-free and cumulative survival rates were compared between the two treatment groups.

Results

A total of 154 patients with HCC (60 MWA and 94 RFA) were treated via the laparoscopic approach. Major complication rates were identified as 1 and 2 % in the RFA and MWA groups, respectively (p = 0.747). Complete ablation rates were 95 % for both treatment groups (p = 0.931), and LTP rates were 21.2 % for RFA and 8.3 % for MWA (p = 0.034). Disease-free survival rates at 5 years were 19 % in the RFA group and 12 % in the MWA group (p = 0.434), while cumulative survival rates at 5 years were 50 % in the RFA group and 37 % in the MWA group (p = 0.185).

Conclusion

Laparoscopic RFA and MWA appear to be safe in the treatment of early-stage HCC. The LTP rates were lower in the laparoscopic MWA group compared with the laparoscopic RFA group, but their respective overall and disease-free survival rates remained similar.
Anhänge
Nur mit Berechtigung zugänglich
Literatur
1.
Zurück zum Zitat Colombo M, Sangiovanni A. Treatment of hepatocellular caricnoma: beyond international guidelines. Liver Int. 2015; 35 Suppl 1:129–38.CrossRefPubMed Colombo M, Sangiovanni A. Treatment of hepatocellular caricnoma: beyond international guidelines. Liver Int. 2015; 35 Suppl 1:129–38.CrossRefPubMed
2.
Zurück zum Zitat Livraghi T, Meloni F, Di Stasi M, Rolle E, Solbiati L, Tinelli C, et al. Sustained complete response and complications rates after radiofrequency ablation of very early hepatocellular carcinoma in cirrhosis: is resection still the treatment of choice? Hepatology. 2008;47:82–89.CrossRefPubMed Livraghi T, Meloni F, Di Stasi M, Rolle E, Solbiati L, Tinelli C, et al. Sustained complete response and complications rates after radiofrequency ablation of very early hepatocellular carcinoma in cirrhosis: is resection still the treatment of choice? Hepatology. 2008;47:82–89.CrossRefPubMed
4.
Zurück zum Zitat De Lope CR, Tremosini S, Forner A, Reig M, Bruix J. Management of HCC. J Hepatol. 2012;56 Suppl 1:S75–87.CrossRefPubMed De Lope CR, Tremosini S, Forner A, Reig M, Bruix J. Management of HCC. J Hepatol. 2012;56 Suppl 1:S75–87.CrossRefPubMed
5.
Zurück zum Zitat Li L, Zhang J, Liu X, Li X, Jiao B, Kang T. Clinical outcomes of radiofrequency ablation and surgical resection for small hepatocellular carcinoma: a meta-analysis. J Gastroenterol Hepatol. 2012;27:51–58.CrossRefPubMed Li L, Zhang J, Liu X, Li X, Jiao B, Kang T. Clinical outcomes of radiofrequency ablation and surgical resection for small hepatocellular carcinoma: a meta-analysis. J Gastroenterol Hepatol. 2012;27:51–58.CrossRefPubMed
6.
Zurück zum Zitat Huang J, Yan L, Cheng Z, et al. A randomized trial comparing radiofrequency ablation and surgical resection for HCC conforming to Milan criteria. Ann Surg. 2010;252:903–12.CrossRefPubMed Huang J, Yan L, Cheng Z, et al. A randomized trial comparing radiofrequency ablation and surgical resection for HCC conforming to Milan criteria. Ann Surg. 2010;252:903–12.CrossRefPubMed
7.
Zurück zum Zitat Cho YC, Kim JK, Kim WT, Chung JW. Hepatic resection versus radiofrequency ablation for very early stage hepatocellular carcinoma: a Markov model analysis. Hepatology. 2010;51:1284–90.CrossRefPubMed Cho YC, Kim JK, Kim WT, Chung JW. Hepatic resection versus radiofrequency ablation for very early stage hepatocellular carcinoma: a Markov model analysis. Hepatology. 2010;51:1284–90.CrossRefPubMed
8.
Zurück zum Zitat Kuang M, Xie XY, Huang C, et al. Long-term outcome of percutaneous ablation in very early-stage hepatocellular carcinoma. J Gastrointest Surg. 2011;15:2165–71.CrossRefPubMed Kuang M, Xie XY, Huang C, et al. Long-term outcome of percutaneous ablation in very early-stage hepatocellular carcinoma. J Gastrointest Surg. 2011;15:2165–71.CrossRefPubMed
9.
Zurück zum Zitat Wang JH, Wang CC, Hung CH, Chen CL, Lu SN. Survival comparison between surgical resection and radiofrequency ablation for patients in BCLC very early/early stage hepatocellular carcinoma. J Hepatol. 2012;56:412–8.CrossRefPubMed Wang JH, Wang CC, Hung CH, Chen CL, Lu SN. Survival comparison between surgical resection and radiofrequency ablation for patients in BCLC very early/early stage hepatocellular carcinoma. J Hepatol. 2012;56:412–8.CrossRefPubMed
10.
Zurück zum Zitat Ke S, Ding XM, Qian XJ, Zhou YM, Cao BX, Gao K, et al. Radiofrequency ablation of hepatocellular carcinoma sized >3 and <5 cm: is ablative margin of more than 1 cm justified?. World J Gastroenterol. 2013;14:7389–7398.CrossRef Ke S, Ding XM, Qian XJ, Zhou YM, Cao BX, Gao K, et al. Radiofrequency ablation of hepatocellular carcinoma sized >3 and <5 cm: is ablative margin of more than 1 cm justified?. World J Gastroenterol. 2013;14:7389–7398.CrossRef
11.
Zurück zum Zitat Huang HW. Influence of blood vessel on the thermal lesion formation during radiofrequency ablation for liver tumors. Med Phys. 2013;40:073303.CrossRefPubMed Huang HW. Influence of blood vessel on the thermal lesion formation during radiofrequency ablation for liver tumors. Med Phys. 2013;40:073303.CrossRefPubMed
12.
Zurück zum Zitat Lu DSK, Raman SS, Limanond P, Aziz D, Economou J, Busuttil R, et al. Influence of large peritumoral vessels on outcome of radiofrequency ablation of liver tumors. J Vasc Interv Radiol. 2003;14:1267–1274.CrossRefPubMed Lu DSK, Raman SS, Limanond P, Aziz D, Economou J, Busuttil R, et al. Influence of large peritumoral vessels on outcome of radiofrequency ablation of liver tumors. J Vasc Interv Radiol. 2003;14:1267–1274.CrossRefPubMed
13.
14.
Zurück zum Zitat Huang S, Yu J, Liang P, Yu X, Cheng Z, Han Z, et al. Percutaneous microwave ablation for hepatocellular carcinoma adjacent to large vessels: a long-term follow-up. Eur J Radiol. 2014;83:552–558.CrossRefPubMed Huang S, Yu J, Liang P, Yu X, Cheng Z, Han Z, et al. Percutaneous microwave ablation for hepatocellular carcinoma adjacent to large vessels: a long-term follow-up. Eur J Radiol. 2014;83:552–558.CrossRefPubMed
15.
Zurück zum Zitat Chung MH, Wood TF, Tsioulias GJ, Rose DM, Bilchik AJ. Laparoscopic radiofrequency ablation of unresectable hepatic malignancies. A phase 2 trial. Surg Endosc. 2001;15:1020–6.CrossRefPubMed Chung MH, Wood TF, Tsioulias GJ, Rose DM, Bilchik AJ. Laparoscopic radiofrequency ablation of unresectable hepatic malignancies. A phase 2 trial. Surg Endosc. 2001;15:1020–6.CrossRefPubMed
16.
Zurück zum Zitat Santambrogio R, Opocher E, Costa M, Cappellani A, Montorsi M. Survival and intra-hepatic recurrences after laparoscopic radiofrequency of hepatocellular carcinoma in patients with liver cirrhosis. J Surg Oncol. 2005;89:218–26.CrossRefPubMed Santambrogio R, Opocher E, Costa M, Cappellani A, Montorsi M. Survival and intra-hepatic recurrences after laparoscopic radiofrequency of hepatocellular carcinoma in patients with liver cirrhosis. J Surg Oncol. 2005;89:218–26.CrossRefPubMed
17.
Zurück zum Zitat Ballem N, Berber E, Pitt T, Siperstein A. Laparoscopic radiofrequency ablation of unresectable hepatocellular carcinoma: long-term follow-up. HPB (Oxford) 2008;10:315–20.CrossRef Ballem N, Berber E, Pitt T, Siperstein A. Laparoscopic radiofrequency ablation of unresectable hepatocellular carcinoma: long-term follow-up. HPB (Oxford) 2008;10:315–20.CrossRef
18.
Zurück zum Zitat De la Serna S, Vilana R, Sanchez-Cabus S, et al. Results of laparoscopic radiofrequency ablation of HCC. Could the location of the tumor influence a complete response to treatment? A single European experience. HPB (Oxford). 2015;17:387–93.CrossRef De la Serna S, Vilana R, Sanchez-Cabus S, et al. Results of laparoscopic radiofrequency ablation of HCC. Could the location of the tumor influence a complete response to treatment? A single European experience. HPB (Oxford). 2015;17:387–93.CrossRef
19.
Zurück zum Zitat Santambrogio R, Barabino M, Bruno S, et al. Long-term outcome of laparoscopic ablation therapies for unresectable hepatocellular carcinoma: a single European center experience of 426 patients. Surg Endosc 2016;30:2103–13.CrossRefPubMed Santambrogio R, Barabino M, Bruno S, et al. Long-term outcome of laparoscopic ablation therapies for unresectable hepatocellular carcinoma: a single European center experience of 426 patients. Surg Endosc 2016;30:2103–13.CrossRefPubMed
20.
Zurück zum Zitat Lo CM, Lai ECS, Liu CL, Fan ST, Wong J. Laparoscopy and laparoscopic ultrasonography avoid exploratory laparotomy in patients with hepatocellular carcinoma. Ann Surg. 1998;227:527–32.CrossRefPubMedPubMedCentral Lo CM, Lai ECS, Liu CL, Fan ST, Wong J. Laparoscopy and laparoscopic ultrasonography avoid exploratory laparotomy in patients with hepatocellular carcinoma. Ann Surg. 1998;227:527–32.CrossRefPubMedPubMedCentral
21.
Zurück zum Zitat Kim PN, Choi D, Rhim H, et al. Planning ultrasound for percutaneous radiofrequency ablation to treat (<3 cm) hepatocellular carcinomas detected on computed tomography or magnetic resonance imaging: a multicenter prospective study to assess factors affecting ultrasound visibility. J Vasc Interv Radiol. 2012;23:627–634.CrossRefPubMed Kim PN, Choi D, Rhim H, et al. Planning ultrasound for percutaneous radiofrequency ablation to treat (<3 cm) hepatocellular carcinomas detected on computed tomography or magnetic resonance imaging: a multicenter prospective study to assess factors affecting ultrasound visibility. J Vasc Interv Radiol. 2012;23:627–634.CrossRefPubMed
22.
Zurück zum Zitat Kim JE, Kim YS, Rhim H, et al. Outcomes of patients with hepatocellular carcinoma referred for percutaneous radiofrequency ablation at a tertiary center: analysis focused on the feasibility with the use of ultrasonography guidance. Eur J Radiol. 2011;79:e80–4.CrossRefPubMed Kim JE, Kim YS, Rhim H, et al. Outcomes of patients with hepatocellular carcinoma referred for percutaneous radiofrequency ablation at a tertiary center: analysis focused on the feasibility with the use of ultrasonography guidance. Eur J Radiol. 2011;79:e80–4.CrossRefPubMed
23.
Zurück zum Zitat Rhim H, Lee MH, Kim YS, Choi D, Lee WJ, Lim HK. Planning sonography to assess the feasibility of percutaneous radiofrequency ablation of hepatocellular carcinomas. AJR Am J Roentgenol. 2008;190:1324–1330.CrossRefPubMed Rhim H, Lee MH, Kim YS, Choi D, Lee WJ, Lim HK. Planning sonography to assess the feasibility of percutaneous radiofrequency ablation of hepatocellular carcinomas. AJR Am J Roentgenol. 2008;190:1324–1330.CrossRefPubMed
24.
Zurück zum Zitat Machi J. Intraoperative and laparoscopic ultrasound. Surg Oncol Clin N Am. 1999;8:205–226.PubMed Machi J. Intraoperative and laparoscopic ultrasound. Surg Oncol Clin N Am. 1999;8:205–226.PubMed
25.
Zurück zum Zitat Santambrogio R, Bianchi P, Pasta A, Palmisano A, Montorsi M. Ultrasound-guided interventional procedures fo the liver during laparoscopy. Technical considerations. Surg Endosc. 2002;16:349–54.CrossRefPubMed Santambrogio R, Bianchi P, Pasta A, Palmisano A, Montorsi M. Ultrasound-guided interventional procedures fo the liver during laparoscopy. Technical considerations. Surg Endosc. 2002;16:349–54.CrossRefPubMed
26.
Zurück zum Zitat Santambrogio R, Opocher E. Diagnostic laparoscoy and allied technology. In: Calise F, Casciola G, editors. Minimally invasive surgery of the liver (updates in surgery). Milan:Springer-Verlag; 2013. p. 83–94.CrossRef Santambrogio R, Opocher E. Diagnostic laparoscoy and allied technology. In: Calise F, Casciola G, editors. Minimally invasive surgery of the liver (updates in surgery). Milan:Springer-Verlag; 2013. p. 83–94.CrossRef
28.
Zurück zum Zitat Dindo D, Demartines N, Clavien PA. Classification of surgical complications. A new proposal with evaluation in a cohort of 633 patients and results of a survey. Ann Surg. 2004;240:205–13.CrossRefPubMedPubMedCentral Dindo D, Demartines N, Clavien PA. Classification of surgical complications. A new proposal with evaluation in a cohort of 633 patients and results of a survey. Ann Surg. 2004;240:205–13.CrossRefPubMedPubMedCentral
29.
30.
Zurück zum Zitat Mulier S, Ni Y, Jamart J, Ruers T, Marchal G, Michel L. Local recurrence after hepatic radiofrequency coagulation. Multivariate meta-analysis and review of contributing factors. Ann Surg. 2005;242:158–171.CrossRefPubMedPubMedCentral Mulier S, Ni Y, Jamart J, Ruers T, Marchal G, Michel L. Local recurrence after hepatic radiofrequency coagulation. Multivariate meta-analysis and review of contributing factors. Ann Surg. 2005;242:158–171.CrossRefPubMedPubMedCentral
31.
Zurück zum Zitat Livraghi T, Meloni F, Solbiati L, Zanus G; Collaborative Italian Group using AMICA system. Complications of microwave ablation for liver tumors: results of a multicenter study. Cardiovasc Interv Radiol. 2012;35:868–874.CrossRefPubMed Livraghi T, Meloni F, Solbiati L, Zanus G; Collaborative Italian Group using AMICA system. Complications of microwave ablation for liver tumors: results of a multicenter study. Cardiovasc Interv Radiol. 2012;35:868–874.CrossRefPubMed
32.
Zurück zum Zitat Bertot LC, Sato M, Tateishi R, Yoshida H, Koike K. Mortality and complication rates of percutaneous ablative techniques for the treatment of liver tumors: a systematic review. Eur Radiol. 2011;21:2584–96.CrossRefPubMed Bertot LC, Sato M, Tateishi R, Yoshida H, Koike K. Mortality and complication rates of percutaneous ablative techniques for the treatment of liver tumors: a systematic review. Eur Radiol. 2011;21:2584–96.CrossRefPubMed
33.
Zurück zum Zitat Chinnaratha MA, Chuang MA, Fraser RJ, Woodman RJ, Wigg AJ. Percutaneous thermal ablation for primary hepatocellular carcinoma: a systematic review and meta-analysis. J Gastroenterol Hepatol. 2016;31:294–301.CrossRefPubMed Chinnaratha MA, Chuang MA, Fraser RJ, Woodman RJ, Wigg AJ. Percutaneous thermal ablation for primary hepatocellular carcinoma: a systematic review and meta-analysis. J Gastroenterol Hepatol. 2016;31:294–301.CrossRefPubMed
34.
Zurück zum Zitat Poulou LS, Botsa E, Thanou I, Ziakas PD, Thanos L. Percutaneous microwave ablation vs radiofrequency ablation in the treatment of hepatocellular carcinoma. World J Hepatol. 2015;7:1054–1063.CrossRefPubMedPubMedCentral Poulou LS, Botsa E, Thanou I, Ziakas PD, Thanos L. Percutaneous microwave ablation vs radiofrequency ablation in the treatment of hepatocellular carcinoma. World J Hepatol. 2015;7:1054–1063.CrossRefPubMedPubMedCentral
35.
Zurück zum Zitat Lencioni R, De Baere T, Martin RC, Nutting CW, Narayanan G. Image-guided ablation of malignant liver tumors: recommendations for clinical validation of novel thermal or non-thermal technologies—a Western perspective. Liver Cancer. 2015;4:208–2014.CrossRefPubMedPubMedCentral Lencioni R, De Baere T, Martin RC, Nutting CW, Narayanan G. Image-guided ablation of malignant liver tumors: recommendations for clinical validation of novel thermal or non-thermal technologies—a Western perspective. Liver Cancer. 2015;4:208–2014.CrossRefPubMedPubMedCentral
36.
Zurück zum Zitat Dodd JD, Dodd NA, Lanctot AC, Glueck DA. Effect of variation of portal venous blood flow on radiofrequency and microwave ablations in a blood-perfused bovine liver model. Radiology. 2013;267:129–36.CrossRefPubMed Dodd JD, Dodd NA, Lanctot AC, Glueck DA. Effect of variation of portal venous blood flow on radiofrequency and microwave ablations in a blood-perfused bovine liver model. Radiology. 2013;267:129–36.CrossRefPubMed
37.
Zurück zum Zitat Ohmoto K, Yoshioka N, Tomiyama Y, et al. Comparison of therapeutic effects between radiofrequency ablation and percutaneous microwave coagulation therapy for small hepatocellular carcinoma. J Gastroenterol Hepatol. 2009;24:223–7.CrossRefPubMed Ohmoto K, Yoshioka N, Tomiyama Y, et al. Comparison of therapeutic effects between radiofrequency ablation and percutaneous microwave coagulation therapy for small hepatocellular carcinoma. J Gastroenterol Hepatol. 2009;24:223–7.CrossRefPubMed
38.
Zurück zum Zitat Ding J, Jing X, Liu J, Wang Y, Wang F, Wang Y, et al. Comparison of two different thermal techniques for the treatment of hepatocelllular carcinoma. Eur J Radiol. 2013;82:1379–84.CrossRefPubMed Ding J, Jing X, Liu J, Wang Y, Wang F, Wang Y, et al. Comparison of two different thermal techniques for the treatment of hepatocelllular carcinoma. Eur J Radiol. 2013;82:1379–84.CrossRefPubMed
39.
Zurück zum Zitat Chinnaratha MA, Sathananthan D, Pateria P, et al High local recurrence of early-stage hepatocellular carcinoma after percutaneous thermal ablation in routine clinical practice. Eur J Gastroenterol Hepatol. 2015;27:349–54.CrossRefPubMed Chinnaratha MA, Sathananthan D, Pateria P, et al High local recurrence of early-stage hepatocellular carcinoma after percutaneous thermal ablation in routine clinical practice. Eur J Gastroenterol Hepatol. 2015;27:349–54.CrossRefPubMed
40.
Zurück zum Zitat Takahashi S, Kudo M, Chung H, et al. Initial treatment response is essential to improve survival in patients with hepatocellular carcinoma who underwent curative radiofrequency ablation therapy. Oncology. 2007;72 Suppl 1:98–103.CrossRefPubMed Takahashi S, Kudo M, Chung H, et al. Initial treatment response is essential to improve survival in patients with hepatocellular carcinoma who underwent curative radiofrequency ablation therapy. Oncology. 2007;72 Suppl 1:98–103.CrossRefPubMed
Metadaten
Titel
Comparison of Laparoscopic Microwave to Radiofrequency Ablation of Small Hepatocellular Carcinoma (≤3 cm)
verfasst von
Roberto Santambrogio, MD
Jason Chiang, MD, PhD
Matteo Barabino, MD
Franca Maria Meloni, MD
Emanuela Bertolini, MD
Fabio Melchiorre, MD
Enrico Opocher, MD
Publikationsdatum
31.08.2016
Verlag
Springer International Publishing
Erschienen in
Annals of Surgical Oncology / Ausgabe 1/2017
Print ISSN: 1068-9265
Elektronische ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-016-5527-2

Weitere Artikel der Ausgabe 1/2017

Annals of Surgical Oncology 1/2017 Zur Ausgabe

Update Chirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

S3-Leitlinie „Diagnostik und Therapie des Karpaltunnelsyndroms“

CME: 2 Punkte

Prof. Dr. med. Gregor Antoniadis Das Karpaltunnelsyndrom ist die häufigste Kompressionsneuropathie peripherer Nerven. Obwohl die Anamnese mit dem nächtlichen Einschlafen der Hand (Brachialgia parästhetica nocturna) sehr typisch ist, ist eine klinisch-neurologische Untersuchung und Elektroneurografie in manchen Fällen auch eine Neurosonografie erforderlich. Im Anfangsstadium sind konservative Maßnahmen (Handgelenksschiene, Ergotherapie) empfehlenswert. Bei nicht Ansprechen der konservativen Therapie oder Auftreten von neurologischen Ausfällen ist eine Dekompression des N. medianus am Karpaltunnel indiziert.

Prof. Dr. med. Gregor Antoniadis
Berufsverband der Deutschen Chirurgie e.V.

S2e-Leitlinie „Distale Radiusfraktur“

CME: 2 Punkte

Dr. med. Benjamin Meyknecht, PD Dr. med. Oliver Pieske Das Webinar S2e-Leitlinie „Distale Radiusfraktur“ beschäftigt sich mit Fragen und Antworten zu Diagnostik und Klassifikation sowie Möglichkeiten des Ausschlusses von Zusatzverletzungen. Die Referenten erläutern, welche Frakturen konservativ behandelt werden können und wie. Das Webinar beantwortet die Frage nach aktuellen operativen Therapiekonzepten: Welcher Zugang, welches Osteosynthesematerial? Auf was muss bei der Nachbehandlung der distalen Radiusfraktur geachtet werden?

PD Dr. med. Oliver Pieske
Dr. med. Benjamin Meyknecht
Berufsverband der Deutschen Chirurgie e.V.

S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“

CME: 2 Punkte

Dr. med. Mihailo Andric
Inhalte des Webinars zur S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“ sind die Darstellung des Projektes und des Erstellungswegs zur S1-Leitlinie, die Erläuterung der klinischen Relevanz der Klassifikation EAES 2015, die wissenschaftliche Begründung der wichtigsten Empfehlungen und die Darstellung stadiengerechter Therapieoptionen.

Dr. med. Mihailo Andric
Berufsverband der Deutschen Chirurgie e.V.