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Application of Laparoscopic Hepatectomy Combined with Intraoperative Microwave Ablation in Colorectal Cancer Liver Metastasis

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Microwave ablation for hepatic malignancies: a multiinstitutional analysis.

Ryan T Groeschl¹, Charles H C Pilgrim, Erin M Hanna

¹*Department of Surgery, Medical College of Wisconsin; Milwaukee, WI †Department of General Surgery, Carolinas Medical Center; Charlotte, NC ‡Division of Surgical Oncology, Ohio State University Wexner Medical Center; Columbus, OH §Department of Radiology, Ohio State University Wexner Medical Center; Columbus, OH ¶Department of Surgery, University of Louisville; Louisville, KY ∥Department of Radiology, Medical College of Wisconsin; Milwaukee, WI.

Annals of Surgery

|October 8, 2013

Summary

Tumor size of 3 cm or more is linked to earlier recurrence after microwave ablation (MWA) for liver cancer. While MWA is effective, percutaneous approaches and hepatocellular carcinoma (HCC) show higher local recurrence rates.

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Area of Science:

Hepatobiliary surgery
Oncology
Minimally invasive procedures

Background:

Microwave ablation (MWA) is increasingly used in hepatobiliary centers for liver malignancies.
Factors influencing local control and recurrence after MWA require further elucidation.

Purpose of the Study:

To investigate the impact of tumor characteristics and surgical approach on MWA success and recurrence-free survival.
To identify predictors of local control and long-term outcomes in patients undergoing MWA for hepatic malignancies.

Main Methods:

A retrospective analysis of consecutive patients with hepatic malignancy treated with MWA across four high-volume institutions (2003-2011).
Patients were grouped by histology: hepatocellular carcinoma (HCC), colorectal liver metastases, neuroendocrine liver metastases, and other cancers.
Logistic regression and Cox proportional hazards models were used to assess the significance of outcome variables.

Main Results:

Complete ablation was achieved in 97.0% of 865 tumors.
Local recurrence rates were 6.0% overall, with higher rates for HCC (10.1%) and percutaneously treated lesions (14.1%).
Tumor size ≥3 cm was a significant predictor of poorer recurrence-free survival (HR: 1.60).

Conclusions:

Tumor size ≥3 cm is associated with an increased risk of early recurrence following MWA, irrespective of tumor histology.
Hepatocellular carcinoma (HCC) demonstrated higher local recurrence rates, potentially linked to underlying liver disease.
While surgical approach did not significantly impact morbidity or survival, percutaneous MWA was associated with higher local recurrence rates.