title: The pilot experience upon surgical ablation of large liver tumor by microwave system with tissue permittivity feedback control mechanism.
abstract: BACKGROUND
  Microwave ablation (MWA) is used to treat patients with unresectable liver cancer. Our institution applied a novel microwave generator capable of automatically adjusting energy levels based on feedback related to tissue permittivity. This approach is meant to facilitate ablations over larger areas and provide results of greater predictablility. This paper reports on the safety, efficacy, and feasibility of this new system in the treatment of patients with large liver tumors.
  
  
  METHODS
  Between July 2012 and December 2012, a total of 23 patients with malignant liver tumors exceeding 4 cm in diameter underwent surgical MWA using a 902-928 MHz generator. The proposed system used a 14-gauge antenna without internal-cooling. Follow up on tumor recurrence was performed using contrast-enhanced computed tomography or magnetic resonance imaging at 1 month and then at 3 month intervals for a period of at least 12 months following ablation.
  
  
  RESULTS
  Among the cancers treated, 10 were primary hepatocellular carcinomas (HCCs) and 13 were metastatic lesions from primary colorectal cancer (CRLM). The mean tumor size was 5.40 cm (range of 4.0-7.0 cm). A total of 18 patients underwent MWA via open surgery, and 5 received laparoscopic MWA. The mean ablation time was 1982 seconds, with a range of 900-3600 seconds, and the median number of ablation sessions was 2.0 (range of 1-4 sessions). The rate of complete ablation, as defined by a total loss of contrast-enhancement one month post-treatment, was 82.6% (19 of 23 patients), and the rate of local recurrence was 26.3% (5 of 19 patients). For tumors with a diameter of 4.0-7.0 cm, the technical success rate of MWA was higher for HCC patients (70%) than for metastatic liver cancer (53.8%) patients; however, the difference was not statistically significant. All patients survived throughout the observation period, and the morbidity rate was 8.6%.
  
  
  CONCLUSIONS
  MWA treatment using the proposed system with tissue permittivity feedback control resulted in a high rate of complete ablation and reduced morbidity. This approach proved to be a fast, easy, and effective option for the ablation of large liver cancers, particularly HCCs.
authors.forename: Po-Chin
authors.initials: PC
authors.lastname: Liang
authors.forename: Hong-Shiee
authors.initials: HS
authors.lastname: Lai
authors.forename: Tiffany Ting-Fang
authors.initials: TT
authors.lastname: Shih
authors.forename: Chih-Horng
authors.initials: CH
authors.lastname: Wu
authors.affiliation: Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan. skywing@ntuh.gov.tw.
authors.forename: Kai-Wen
authors.initials: KW
authors.lastname: Huang
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis / Q000601:surgery*; D003972:Diathermy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008113:Liver Neoplasms / Q000175:diagnosis / Q000601:surgery*; D008297:Male; D008872:Microwaves / Q000627:therapeutic use*; D008875:Middle Aged; D009367:Neoplasm Staging; D010865:Pilot Projects; D012189:Retrospective Studies; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome