Abstract

Background: Based on patient and tumor characteristics, some authors favor laparoscopic microwave ablation (LMWA) over the percutaneous approach (PMWA) for treatment of hepatocellular carcinoma (HCC). We compared the two techniques in terms of technique efficacy, local tumor progression (LTP) and complication rates.

Study design: A retrospective comparative analysis was performed on 91 consecutive patients (102 HCC tumors) who underwent PMWA or LMWA between October 2014 and May 2019. Technique efficacy at one-month and LTP at follow-up were assessed by contrast-enhanced CT/MRI. Kaplan–Meier estimates and Cox regression were used to compare LTP-free survival (LTPFS).

Results: At baseline analysis, LMWA group showed higher frequency of multinodular disease (p < .001) and average higher energy delivered over tumor size (p = .033); PMWA group showed higher rates of non-treatment-naïve patients (p = .001), patients with Hepatitis-C (p = .03) and BCLC-A1 disease (p = .006). Technique efficacy was not significantly different between the two groups (p = .18). Among effectively treated patients, 75 (83 tumors) satisfied ≥6 months follow-up, 54 (57 tumors) undergoing PMWA and 21 (26 tumors) LMWA. LTP occurred in 14/83 cases (16.9%): 12 after PMWA (21.1%) and 2 after LMWA (7.7%). At univariate analysis, technique did not correlate to LTPFS (p = .28). Subgroup analysis showed a trend toward worse LTPFS after PMWA of subcapsular tumors (p = .16). Major complications were observed in six patients (6.6%), 2 after PMWA and 4 after LMWA (3.2% vs 14.3%, p = .049).

Conclusions: Technical approach did not affect LTPFS. Complications were reported more frequently after LMWA. Despite higher complication rates, LMWA seems a valid option for treatment of subcapsular tumors.

摘要

背景：基于患者和肿瘤的特征，一些作者主张腹腔镜微波消融（LMWA）优于经皮途径（PMWA）来治疗肝细胞癌（HCC）。我们在技术功效，局部肿瘤进展（LTP）和并发症发生率方面比较了两种技术。

研究设计：对2014年10月至2019年5月间接受PMWA或LMWA的91例连续患者（102例HCC肿瘤）进行回顾性比较分析。通过增强CT / CT评估了一个月的技术疗效和随访的LTP核磁共振 Kaplan–Meier估计和Cox回归用于比较无LTP生存期（LTPFS）。

结果：在基线分析中，LMWA组显示多结节病的发生率更高（p  <.001），并且在肿瘤大小范围内平均传递的能量更高（p  = .033）；PMWA组的未治疗初治患者（p  = .001），丙型肝炎（p  = .03）和BCLC-A1疾病（p  = .006）的发生率更高。两组之间的技术效力无明显差异（p  = .18）。在有效治疗的患者中，有75例（83个肿瘤）获得了≥6个月的随访，其中54例（57个肿瘤）接受了PMWA和21例（26个肿瘤）LMWA。LTP发生在14/83例中（16.9％）：PMWA后为12（21.1％），LMWA后为2（7.7％）。在单变量分析中，技术与LTPFS不相关（p  = 0.28）。亚组分析显示了包膜下肿瘤PMWA后LTPFS恶化的趋势（p  = .16）。在6例患者（6.6％）中观察到主要并发症，在PMWA后2例，在LMWA后4例（3.2％vs 14.3％，p  = .049）。

结论：技术方法不影响LTPFS。LMWA术后并发症的报道更为频繁。尽管并发症发生率较高，LMWA似乎是治疗包膜下肿瘤的有效选择。