title: Operative microwave ablation for hepatocellular carcinoma: complications, recurrence, and long-term outcomes.
abstract: BACKGROUND
  Treatment of hepatocellular carcinoma (HCC) in the setting of cirrhosis is limited by tumor size/location and underlying liver disease. Radiofrequency ablation is utilized in selected patients; however, local recurrence remains a concern. Microwave ablation (MWA) delivers energy to tissue in a unique fashion, reducing local recurrence. A minimally invasive operative approach allows for mobilization/protection of adjacent structures, intra-operative ultrasound, and assessment of ablation progress.
  
  
  METHODS
  Retrospective review of operative MWA performed for HCC in patients with cirrhosis over a 4-year period at a single center. Complications were stratified by Clavien-Dindo classification. Incomplete ablation and local, regional, and metastatic recurrence was assessed on follow-up imaging. Survival was assessed in months.
  
  
  RESULTS
  Fifty-four patients with 73 tumors underwent MWA. Median tumor size was 2.6 cm (range 0.5-8.5 cm). Cirrhosis was present in 92.6 % of patients, with a Child-Pugh score of B/C in 27.8 % and hepatitis C present in 59.3 %. A minimally invasive approach was used in 94.5 % of patients. There were no deaths within 30 days. Thirty-day morbidity was 28.9 %, with grade III complications present in 11.5 %. Delayed complications occurred in 7.8 % of patients, with a 5.6 % 90-day mortality. Incomplete ablation was identified in 5.9 % of tumors with local recurrence of 2.9 % at 9 months median follow-up. Regional and metastatic recurrence occurred in 27.5 and 11.8 % at 9 months median follow-up. Median survival was not reached at 11 months median follow-up. One- and 2-year survival was 72.3 and 58.8 %.
  
  
  CONCLUSIONS
  Operative, preferably minimally invasive, MWA can be performed in cirrhotic patients with HCC with acceptable morbidity and low recurrence rates. High regional and metastatic recurrence rates in these patients underscore the need for minimally invasive, low morbidity approaches to liver-directed therapy.
authors: Hepato-Pancreato-Biliary Surgery, Department of General Surgery, Carolinas Medical Center, 1025 Morehead Medical Drive, Suite 300, Charlotte, NC 28204, USA.
authors: Ryan Z
authors: RZ
authors: Swan
authors: David
authors: D
authors: Sindram
authors: John B
authors: JB
authors: Martinie
authors: David A
authors: DA
authors: Iannitti
mesh_terms: D055011:Ablation Techniques / Q000009:adverse effects* / Q000379:methods*; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000150:complications / Q000601:surgery*; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications; D008113:Liver Neoplasms / Q000150:complications / Q000601:surgery*; D008297:Male; D008872:Microwaves / Q000627:therapeutic use; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology*; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome
references: J Hepatobiliary Pancreat Sci. 2010 Jul;17(4):425-9
references: 19890600
references: Acad Radiol. 1996 Mar;3(3):212-8
references: 8796667
references: Clin Radiol. 2004 Jan;59(1):53-61
references: 14697375
references: Semin Liver Dis. 2010 Feb;30(1):1-2
references: 20175028
references: Crit Rev Biomed Eng. 2010;38(1):65-78
references: 21175404
references: N Engl J Med. 1999 Mar 11;340(10):745-50
references: 10072408
references: AJR Am J Roentgenol. 2001 Mar;176(3):789-95
references: 11222227
references: J Gastroenterol. 2005 Nov;40(11):1054-60
references: 16322950
references: Ann Surg. 1998 Apr;227(4):559-65
references: 9563546
references: HPB (Oxford). 2007;9(2):120-4
references: 18333126
references: Ann Surg. 2005 Aug;242(2):158-71
references: 16041205
references: Lancet. 2003 Dec 6;362(9399):1907-17
references: 14667750
references: Hepatology. 2008 Jan;47(1):82-9
references: 18008357
references: Am J Gastroenterol. 2012 Apr;107(4):569-77; quiz 578
references: 22158026
references: HPB (Oxford). 2010 Jun;12(5):302-10
references: 20590903
references: Curr Probl Diagn Radiol. 2009 Mar-Apr;38(2):61-7
references: 19179193
references: HPB (Oxford). 2010 Jun;12(5):289-99
references: 20590901
references: J Vasc Interv Radiol. 2008 Jul;19(7):1087-92
references: 18589324
references: Ann Surg Oncol. 2010 Jan;17(1):171-8
references: 19707829
references: Eur J Gastroenterol Hepatol. 2009 Jun;21(6):599-605
references: 19282763
references: Eur J Surg Oncol. 2010 Mar;36(3):264-8
references: 19880269
references: Eur Radiol. 2011 Dec;21(12):2584-96
references: 21858539
references: Hepatology. 2009 Nov;50(5):1475-83
references: 19731239
references: J Gastroenterol Hepatol. 2010 Mar;25(3):597-604
references: 20074153
references: Radiographics. 2005 Oct;25 Suppl 1:S69-83
references: 16227498
references: Hepatol Res. 2007 Sep;37 Suppl 2:S88-94
references: 17877502
references: HPB (Oxford). 2011 Jun;13(6):400-3
references: 21609372
references: Radiology. 2005 Jul;236(1):132-9
references: 15987969
references: Radiology. 2005 Mar;234(3):961-7
references: 15665226
references: J Vasc Interv Radiol. 2001 Sep;12(9):1021-32
references: 11535764
references: AJR Am J Roentgenol. 2000 Feb;174(2):323-31
references: 10658699
references: Ann Surg. 2006 Mar;243(3):321-8
references: 16495695
references: Gastroenterology. 2007 Jun;132(7):2557-76
references: 17570226
references: Cardiovasc Intervent Radiol. 2012 Aug;35(4):868-74
references: 21833809
references: Ann Surg. 2010 Dec;252(6):903-12
references: 21107100
references: Ann Surg. 2009 Aug;250(2):187-96
references: 19638912
references: Radiology. 2009 Jun;251(3):933-40
references: 19304921
references: Cancer. 2009 May 1;115(9):1914-23
references: 19241423
references: Open Biomed Eng J. 2007 Sep 19;1:47-52
references: 19662127
references: AJR Am J Roentgenol. 2006 Oct;187(4):W333-40
references: 16985103
references: Cancer. 2005 Mar 15;103(6):1201-9
references: 15690326
references: Hepatology. 2005 Nov;42(5):1208-36
references: 16250051