Stereotactic Image-Guided Microwave Ablation of Hepatocellular Carcinoma using a computer-assisted navigation system.

BACKGROUND & AIMS

Ablation plays an important role in the treatment of hepatocellular carcinoma. Because image-guided navigation technology has recently entered the clinical setting, we aimed to analyze its safety, therapeutic and procedural efficiency.

METHODS

Retrospective analysis of patients treated with stereotactic image-guided microwave ablation between 01/2015 and 12/2017. Interventions were performed using computertomography-guidance with needle trajectory, ablation planning and automatic single-marker patient registration. Needle placement and ablation coverage was controlled by image fusion under general anesthesia with jet-ventilation.

RESULTS

In total 174 ablations were performed in 88 patients during 119 interventions. Mean age was 66 (46-84) years, 74 (84.1%) were men and 74% were Child Pugh Class A. Median tumor size was 16 (4-45) mm, 62.2% were BCLC A. Median lateral and longitudinal error of needle placement were 3.2 (0.2-14.1) and 1.6 (0-15.8) mm. Median one tumor (1-4) was ablated per session. One patient developed a Dindo IIIb (0.8%) complication, 6 minor complications. After re-ablation of 12 lesions, an efficacy rate of 96.3% was achieved. Local tumor progression was 6.3% (11/174). Close proximity to major vessels was significantly correlated with local tumor progression (p<0.05). Median overall follow-up was 17.5 months after intervention and 24 months after initial diagnosis. BCLC stage, child class and previous treatment were significantly correlated with overall survival (p<0.05).

CONCLUSION

Stereotactic image-guided microwave ablation is a safe and efficient treatment for HCC offering a curative treatment approach in general and in particular for lesions not detectable on conventional imaging or untreatable due to difficult anatomic locations. This article is protected by copyright. All rights reserved.