Muglia Riccardo, Marra Paolo, Pinelli Domenico, Dulcetta Ludovico, Carbone Francesco Saverio, Barbaro Alessandro, Celestino Antonio, Colledan Michele, Sironi Sandro
Department of Radiology, Papa Giovanni XXIII Hospital, 24127 Bergamo, Italy.
School of Medicine, University of Milano-Bicocca, 20126 Milano, Italy.
Cancers (Basel). 2023 Dec 24;16(1):92. doi: 10.3390/cancers16010092.
To evaluate technical and clinical outcomes of intraoperative (laparoscopic/laparotomic) microwave ablation on HCC.
This is a retrospective single-center study evaluating consecutive patients treated for very early/early-stage HCC with intraoperative microwave ablation from 1 July 2017 to 30 June 2023. In these patients, a percutaneous US-guided approach was excluded due to the nodule's suboptimal visibility or harmful location and liver resection for a deep position or adherences. Data about the clinical stage, surgical approach, liver pathology and nodules characteristics, technical success, complications, and follow-up were collected. Technical success was intended as the absence of locoregional persistence at follow-up CT/MRI controls.
A total of 36 cirrhotic patients (M:F = 30:6, median age 67 years) were enrolled; 18/36 (50%) had a single nodule, 13/36 (36%) had two, 4/36 had three (11%), and 1/36 had four (3%). Among the patients, 24 (67%) were treated with laparoscopy, and 12/36 (33%) with a laparotomic approach. Sixty HCCs of 16.5 mm (6-50 mm) were treated for 7 min (2-30 min) with 100 W of power. A total of 55 nodules (92%) were treated successfully and showed no residual enhancement at the first postoperative follow-up; the other 5/60 (8%) underwent chemo/radioembolization. There was one complication (3%): a biliary fistula treated with percutaneous drainage and glue embolization. The average hospital stay was 3.5 days (1-51 days), and patients were followed up on average for 238 days (13-1792 days). During follow-up, 5/36 patients (14%) underwent liver transplantation, 1/36 (2%) died during hospitalization and 1 after discharge.
Laparoscopic/laparotomic intraoperative HCC MW ablation is feasible in patients unsuitable for percutaneous approach or hepatic resection, with rare complications and with good technical and clinical outcomes.
评估术中（腹腔镜/开腹）微波消融治疗肝癌的技术和临床效果。
这是一项回顾性单中心研究，评估了2017年7月1日至2023年6月30日期间接受术中微波消融治疗的极早期/早期肝癌患者。在这些患者中，由于结节可视性欠佳或位置不佳以及深部位置或粘连导致肝切除困难，排除了经皮超声引导的方法。收集了有关临床分期、手术方式、肝脏病理和结节特征、技术成功率、并发症及随访的数据。技术成功定义为随访CT/MRI检查时无局部残留。
共纳入36例肝硬化患者（男:女 = 30:6，中位年龄67岁）；18/36（50%）有单个结节，13/36（36%）有两个，4/36有三个（11%），1/36有四个（3%）。患者中，24例（67%）接受腹腔镜治疗，12/36（33%）接受开腹手术。60个直径为16.5 mm（6 - 50 mm）的肝癌结节接受了7分钟（2 - 30分钟）、功率100 W的治疗。共有55个结节（92%）治疗成功，术后首次随访时无残留强化；另外5/60（8%）接受了化疗/放射栓塞治疗。发生1例并发症（3%）：胆瘘，经皮引流和胶水栓塞治疗。平均住院时间为3.5天（1 - 51天），患者平均随访238天（13 - 1792天）。随访期间，5/36例患者（14%）接受了肝移植，1/36（2%）在住院期间死亡，1例在出院后死亡。
对于不适合经皮途径或肝切除的患者，腹腔镜/开腹术中肝癌微波消融是可行的，并发症罕见，技术和临床效果良好。
