Department of Surgery and Transplantation, Rigshospitalet, Copenhagen University Hospital, Inge Lehmanns Vej 7, 2100, Copenhagen, Denmark.
Hepatic Malignancy Surgical Research Unit (HEPSURU), Department of Surgery and Transplantation, Rigshospitalet, Copenhagen University Hospital, Inge Lehmanns Vej 7, 2100, Copenhagen, Denmark.
Surg Endosc. 2024 Oct;38(10):5785-5792. doi: 10.1007/s00464-024-11125-x. Epub 2024 Aug 15.
Ablation is an effective, parenchymal-sparing treatment for primary liver cancer and liver metastases. The purpose of this study was to report our initial experience with laparoscopic microwave ablation regarding postoperative complications, rate of conversions to open procedure, and technical efficacy.
This was a quality improvement project carried out at a tertiary care center in Denmark. Patients ≥ 18 years old with liver malignancies, not available for percutaneous ablation, and treated with ultrasound-guided laparoscopic ablation were included.
From March 2023 to December 2023, 39 patients were referred for laparoscopic ablation after a multidisciplinary team conference. Of these, two procedures were converted to open procedures due to adhesion and tumor progression. Three patients rejected the sharing of medical information, two procedures were canceled and in one case the strategy was changed perioperatively. Therefore, 32 procedures in 31 patients were available for analysis. Complete ablation was evaluated after 1 month and was achieved in 100% of the procedures. None of the patients died, and no complications were reported in 21 cases (65.6%). Most patients with complications had a grade 1 complication based on the Clavien-Dindo classification, which among others included abdominal and shoulder pain, atrial fibrillation, and subcutaneous hematoma. Two patients had a complication grade 2 (wound infection and decompensated cirrhosis) and one had a grade 4b (sepsis due to pneumonia and urinary tract infection). The median Comprehensive Complication Index was 12.2 (interquartile range 8.7-24.2). Furthermore, univariable logistic regression showed that ≥ 2 tumors treated were associated with a higher risk of complications (odds ratio 6.37, 95% confidence interval [1.20;33.85], p-value = 0.0297).
Ultrasound-guided laparoscopic microwave ablation of liver malignancies is feasible and safe with little risk for complications, a high technical efficacy, and a low rate of conversions to open procedures.
消融是原发性肝癌和肝转移瘤的一种有效、保肝的治疗方法。本研究旨在报告我们在腹腔镜微波消融方面的初步经验，包括术后并发症、中转开腹率和技术疗效。
这是在丹麦一家三级保健中心进行的一项质量改进项目。纳入标准为年龄≥18 岁、有肝恶性肿瘤、无法进行经皮消融、且接受超声引导下腹腔镜消融治疗的患者。
2023 年 3 月至 2023 年 12 月，多学科团队会议后有 39 例患者被转诊行腹腔镜消融。其中，2 例因粘连和肿瘤进展中转开腹。3 例患者拒绝共享医疗信息，2 例手术取消，1 例术中策略改变。因此，31 例患者的 32 例手术可用于分析。术后 1 个月评估完全消融，所有手术均达到 100%完全消融。无患者死亡，21 例（65.6%）无并发症报告。大多数并发症患者的并发症分级为 1 级，根据 Clavien-Dindo 分级，还包括腹痛和肩部疼痛、心房颤动和皮下血肿。2 例患者有 2 级并发症（伤口感染和失代偿性肝硬化），1 例有 4b 级并发症（肺炎和尿路感染引起的败血症）。综合并发症指数中位数为 12.2（四分位距 8.7-24.2）。此外，单变量逻辑回归显示，治疗肿瘤数≥2 个与并发症风险增加相关（比值比 6.37，95%置信区间 [1.20；33.85]，p 值=0.0297）。
超声引导下腹腔镜微波消融治疗肝恶性肿瘤是可行且安全的，并发症风险低，技术疗效高，中转开腹率低。
