Efficacy and Safety of Microwave Ablation (MWA) for Hepatocellular Carcinoma (HCC) in Difficult Anatomical Sites in Egyptian Patients with Liver Cirrhosis

Abstract

Background and aim: Imaging guided microwave ablation (MWA) for hepatocellular carcinoma (HCC) has<br />become a widely used method over recent years. Tumors close to the diaphragm, gastrointestinal tract, gallbladder,<br />pancreas, hepatic hilum and major bile duct or vessels are generally considered relative contraindications for microwave<br />ablation. This study was conducted to assess the effectiveness and safety of ultrasonography-guided MWA in treating<br />patients with HCC in difficult anatomical sites in comparison to those in conventional sites. Patients and methods:<br />Eighty-eight patients were included and divided into two groups: the study group of 44 with 46 lesions lying <5mm<br />from the diaphragm, hepatic capsule, gall bladder (GB) or large vessel; and the control group of 44 patients with<br />50 lesions in non-risky sites. Each lesion was ablated using an ultrasound guided microwave probe using a detailed<br />protocol. Results: Most of the patients were males, with a mean age of 57.8 years. In the study group, two patients<br />had lesions adjacent to the GB, twelve were perivascular and 32 were subcapsular. The overall successful ablation<br />rates were 84.8% and 92% in the study and control groups, respectively. Within the study group, ablation rates were<br />100%, 75% and 87.5% for lesions close to the GB, perivascular lesions and subcapsular lesions, respectively. One<br />patient developed a subcutaneous abscess, with good outcome after proper treatment. Fever, pain and asymptomatic<br />pleural effusion were reported after ablation without statistically significant difference between the groups or among<br />subgroups. In conclusion: MWA for HCC in difficult anatomical sites is as effective and safe as for ordinary sites.