Skip to main content
SpringerLink
Log in

Comparison of Laparoscopic Microwave to Radiofrequency Ablation of Small Hepatocellular Carcinoma (≤3 cm)

  • Hepatobiliary Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Laparoscopic thermal ablation is a common alternative to surgical resection in treating hepatic tumors, particularly in those located in difficult-to-reach locations.

Objective

The aim of this study was to compare the safety and long-term efficacy of laparoscopic radiofrequency ablation (RFA) and microwave ablation (MWA) in treating hepatocellular carcinoma (HCC).

Method

From February 2009 to May 2015, data from patients with HCC nodules who had undergone either laparoscopic MWA or laparoscopic RFA were examined. Complications, complete ablation rates, local tumor progression (LTP) rates, and disease-free and cumulative survival rates were compared between the two treatment groups.

Results

A total of 154 patients with HCC (60 MWA and 94 RFA) were treated via the laparoscopic approach. Major complication rates were identified as 1 and 2 % in the RFA and MWA groups, respectively (p = 0.747). Complete ablation rates were 95 % for both treatment groups (p = 0.931), and LTP rates were 21.2 % for RFA and 8.3 % for MWA (p = 0.034). Disease-free survival rates at 5 years were 19 % in the RFA group and 12 % in the MWA group (p = 0.434), while cumulative survival rates at 5 years were 50 % in the RFA group and 37 % in the MWA group (p = 0.185).

Conclusion

Laparoscopic RFA and MWA appear to be safe in the treatment of early-stage HCC. The LTP rates were lower in the laparoscopic MWA group compared with the laparoscopic RFA group, but their respective overall and disease-free survival rates remained similar.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Colombo M, Sangiovanni A. Treatment of hepatocellular caricnoma: beyond international guidelines. Liver Int. 2015; 35 Suppl 1:129–38.

    Article  CAS  PubMed  Google Scholar 

  2. Livraghi T, Meloni F, Di Stasi M, Rolle E, Solbiati L, Tinelli C, et al. Sustained complete response and complications rates after radiofrequency ablation of very early hepatocellular carcinoma in cirrhosis: is resection still the treatment of choice? Hepatology. 2008;47:82–89.

    Article  PubMed  Google Scholar 

  3. Forner A, Llovet JM, Bruix J. Hepatocellular carcinoma. Lancet. 2012;379:1245–55.

    Article  PubMed  Google Scholar 

  4. De Lope CR, Tremosini S, Forner A, Reig M, Bruix J. Management of HCC. J Hepatol. 2012;56 Suppl 1:S75–87.

    Article  PubMed  Google Scholar 

  5. Li L, Zhang J, Liu X, Li X, Jiao B, Kang T. Clinical outcomes of radiofrequency ablation and surgical resection for small hepatocellular carcinoma: a meta-analysis. J Gastroenterol Hepatol. 2012;27:51–58.

    Article  PubMed  Google Scholar 

  6. Huang J, Yan L, Cheng Z, et al. A randomized trial comparing radiofrequency ablation and surgical resection for HCC conforming to Milan criteria. Ann Surg. 2010;252:903–12.

    Article  PubMed  Google Scholar 

  7. Cho YC, Kim JK, Kim WT, Chung JW. Hepatic resection versus radiofrequency ablation for very early stage hepatocellular carcinoma: a Markov model analysis. Hepatology. 2010;51:1284–90.

    Article  PubMed  Google Scholar 

  8. Kuang M, Xie XY, Huang C, et al. Long-term outcome of percutaneous ablation in very early-stage hepatocellular carcinoma. J Gastrointest Surg. 2011;15:2165–71.

    Article  PubMed  Google Scholar 

  9. Wang JH, Wang CC, Hung CH, Chen CL, Lu SN. Survival comparison between surgical resection and radiofrequency ablation for patients in BCLC very early/early stage hepatocellular carcinoma. J Hepatol. 2012;56:412–8.

    Article  PubMed  Google Scholar 

  10. Ke S, Ding XM, Qian XJ, Zhou YM, Cao BX, Gao K, et al. Radiofrequency ablation of hepatocellular carcinoma sized >3 and <5 cm: is ablative margin of more than 1 cm justified?. World J Gastroenterol. 2013;14:7389–7398.

    Article  Google Scholar 

  11. Huang HW. Influence of blood vessel on the thermal lesion formation during radiofrequency ablation for liver tumors. Med Phys. 2013;40:073303.

    Article  PubMed  Google Scholar 

  12. Lu DSK, Raman SS, Limanond P, Aziz D, Economou J, Busuttil R, et al. Influence of large peritumoral vessels on outcome of radiofrequency ablation of liver tumors. J Vasc Interv Radiol. 2003;14:1267–1274.

    Article  PubMed  Google Scholar 

  13. Lubner MG, Brace CL, Ziemlewicz TJ, Hinshaw JL, Lee FT. Microwave ablation of hepatic malignancy. Semin Intervent Radiol. 2013;30:56–66.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Huang S, Yu J, Liang P, Yu X, Cheng Z, Han Z, et al. Percutaneous microwave ablation for hepatocellular carcinoma adjacent to large vessels: a long-term follow-up. Eur J Radiol. 2014;83:552–558.

    Article  PubMed  Google Scholar 

  15. Chung MH, Wood TF, Tsioulias GJ, Rose DM, Bilchik AJ. Laparoscopic radiofrequency ablation of unresectable hepatic malignancies. A phase 2 trial. Surg Endosc. 2001;15:1020–6.

    Article  CAS  PubMed  Google Scholar 

  16. Santambrogio R, Opocher E, Costa M, Cappellani A, Montorsi M. Survival and intra-hepatic recurrences after laparoscopic radiofrequency of hepatocellular carcinoma in patients with liver cirrhosis. J Surg Oncol. 2005;89:218–26.

    Article  PubMed  Google Scholar 

  17. Ballem N, Berber E, Pitt T, Siperstein A. Laparoscopic radiofrequency ablation of unresectable hepatocellular carcinoma: long-term follow-up. HPB (Oxford) 2008;10:315–20.

    Article  Google Scholar 

  18. De la Serna S, Vilana R, Sanchez-Cabus S, et al. Results of laparoscopic radiofrequency ablation of HCC. Could the location of the tumor influence a complete response to treatment? A single European experience. HPB (Oxford). 2015;17:387–93.

    Article  Google Scholar 

  19. Santambrogio R, Barabino M, Bruno S, et al. Long-term outcome of laparoscopic ablation therapies for unresectable hepatocellular carcinoma: a single European center experience of 426 patients. Surg Endosc 2016;30:2103–13.

    Article  PubMed  Google Scholar 

  20. Lo CM, Lai ECS, Liu CL, Fan ST, Wong J. Laparoscopy and laparoscopic ultrasonography avoid exploratory laparotomy in patients with hepatocellular carcinoma. Ann Surg. 1998;227:527–32.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Kim PN, Choi D, Rhim H, et al. Planning ultrasound for percutaneous radiofrequency ablation to treat (<3 cm) hepatocellular carcinomas detected on computed tomography or magnetic resonance imaging: a multicenter prospective study to assess factors affecting ultrasound visibility. J Vasc Interv Radiol. 2012;23:627–634.

    Article  PubMed  Google Scholar 

  22. Kim JE, Kim YS, Rhim H, et al. Outcomes of patients with hepatocellular carcinoma referred for percutaneous radiofrequency ablation at a tertiary center: analysis focused on the feasibility with the use of ultrasonography guidance. Eur J Radiol. 2011;79:e80–4.

    Article  PubMed  Google Scholar 

  23. Rhim H, Lee MH, Kim YS, Choi D, Lee WJ, Lim HK. Planning sonography to assess the feasibility of percutaneous radiofrequency ablation of hepatocellular carcinomas. AJR Am J Roentgenol. 2008;190:1324–1330.

    Article  PubMed  Google Scholar 

  24. Machi J. Intraoperative and laparoscopic ultrasound. Surg Oncol Clin N Am. 1999;8:205–226.

    CAS  PubMed  Google Scholar 

  25. Santambrogio R, Bianchi P, Pasta A, Palmisano A, Montorsi M. Ultrasound-guided interventional procedures fo the liver during laparoscopy. Technical considerations. Surg Endosc. 2002;16:349–54.

    Article  CAS  PubMed  Google Scholar 

  26. Santambrogio R, Opocher E. Diagnostic laparoscoy and allied technology. In: Calise F, Casciola G, editors. Minimally invasive surgery of the liver (updates in surgery). Milan:Springer-Verlag; 2013. p. 83–94.

    Chapter  Google Scholar 

  27. National Cancer Institute. Cancer therapy evaluation program: common toxicity evaluation manual. Version 2.0. 1999. http://www.ctep.cancer.gov/reporting/ctc.html.

  28. Dindo D, Demartines N, Clavien PA. Classification of surgical complications. A new proposal with evaluation in a cohort of 633 patients and results of a survey. Ann Surg. 2004;240:205–13.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Ahmed M. Image-guided tumor ablation: standardization of terminology and reporting criteria—a 10-year update. Radiology. 2014;273:241–260.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Mulier S, Ni Y, Jamart J, Ruers T, Marchal G, Michel L. Local recurrence after hepatic radiofrequency coagulation. Multivariate meta-analysis and review of contributing factors. Ann Surg. 2005;242:158–171.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Livraghi T, Meloni F, Solbiati L, Zanus G; Collaborative Italian Group using AMICA system. Complications of microwave ablation for liver tumors: results of a multicenter study. Cardiovasc Interv Radiol. 2012;35:868–874.

    Article  PubMed  Google Scholar 

  32. Bertot LC, Sato M, Tateishi R, Yoshida H, Koike K. Mortality and complication rates of percutaneous ablative techniques for the treatment of liver tumors: a systematic review. Eur Radiol. 2011;21:2584–96.

    Article  PubMed  Google Scholar 

  33. Chinnaratha MA, Chuang MA, Fraser RJ, Woodman RJ, Wigg AJ. Percutaneous thermal ablation for primary hepatocellular carcinoma: a systematic review and meta-analysis. J Gastroenterol Hepatol. 2016;31:294–301.

    Article  PubMed  Google Scholar 

  34. Poulou LS, Botsa E, Thanou I, Ziakas PD, Thanos L. Percutaneous microwave ablation vs radiofrequency ablation in the treatment of hepatocellular carcinoma. World J Hepatol. 2015;7:1054–1063.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Lencioni R, De Baere T, Martin RC, Nutting CW, Narayanan G. Image-guided ablation of malignant liver tumors: recommendations for clinical validation of novel thermal or non-thermal technologies—a Western perspective. Liver Cancer. 2015;4:208–2014.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  36. Dodd JD, Dodd NA, Lanctot AC, Glueck DA. Effect of variation of portal venous blood flow on radiofrequency and microwave ablations in a blood-perfused bovine liver model. Radiology. 2013;267:129–36.

    Article  PubMed  Google Scholar 

  37. Ohmoto K, Yoshioka N, Tomiyama Y, et al. Comparison of therapeutic effects between radiofrequency ablation and percutaneous microwave coagulation therapy for small hepatocellular carcinoma. J Gastroenterol Hepatol. 2009;24:223–7.

    Article  PubMed  Google Scholar 

  38. Ding J, Jing X, Liu J, Wang Y, Wang F, Wang Y, et al. Comparison of two different thermal techniques for the treatment of hepatocelllular carcinoma. Eur J Radiol. 2013;82:1379–84.

    Article  PubMed  Google Scholar 

  39. Chinnaratha MA, Sathananthan D, Pateria P, et al High local recurrence of early-stage hepatocellular carcinoma after percutaneous thermal ablation in routine clinical practice. Eur J Gastroenterol Hepatol. 2015;27:349–54.

    Article  CAS  PubMed  Google Scholar 

  40. Takahashi S, Kudo M, Chung H, et al. Initial treatment response is essential to improve survival in patients with hepatocellular carcinoma who underwent curative radiofrequency ablation therapy. Oncology. 2007;72 Suppl 1:98–103.

    Article  PubMed  Google Scholar 

Download references

Disclosures

Roberto Santambrogio, Jason Chiang, Matteo Barabino, Franca Maria Meloni, Emanuela Bertolini, Fabio Melchiorre, and Enrico Opocher have no conflicts of interest or financial ties to disclose.

Author information

Authors and Affiliations

  1. UOC di Chirurgia Epato-bilio-pancreatica e Digestiva, Ospedale San Paolo, Università di Milano, Milan, Italy

    Roberto Santambrogio MD, Matteo Barabino MD & Enrico Opocher MD

  2. Department of Radiology, University of Wisconsin, Madison, WI, USA

    Jason Chiang MD, PhD

  3. Servizio di Radiologia Ecografia Interventistica, Ospedale Valduce, Como, Italy

    Franca Maria Meloni MD

  4. Servizio di Radiologia Diagnostica ed Interventistica, Ospedale San Paolo, Università di Milano, Milan, Italy

    Fabio Melchiorre MD

  5. Divisione di Medicina Interna-Epatologia, San Paolo Hospital, University of Milan School of Medicine, Milan, Italy

    Emanuela Bertolini MD

  6. Servizio di radiologia Interventistica e di Procedure Speciali, Casa di Cura Igea, Milan, Italy

    Franca Maria Meloni MD

Authors
  1. Roberto Santambrogio MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jason Chiang MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Matteo Barabino MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Franca Maria Meloni MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Emanuela Bertolini MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Fabio Melchiorre MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Enrico Opocher MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Roberto Santambrogio MD.

Electronic Supplementary Material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOC 34 kb)

Supplementary material 2 (DOC 43 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Santambrogio, R., Chiang, J., Barabino, M. et al. Comparison of Laparoscopic Microwave to Radiofrequency Ablation of Small Hepatocellular Carcinoma (≤3 cm). Ann Surg Oncol 24, 257–263 (2017). https://doi.org/10.1245/s10434-016-5527-2

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-016-5527-2

Keywords

Search

Navigation