Percutaneous Microwave Ablation of Hepatocellular Carcinoma: Proper Lesion Selection and Possible Complications

Abstract

Background: Hepatocellular carcinoma (HCC) represents about 90% of the primary malignant hepatic neoplasms and now it is the third major cause of cancer-related deaths worldwide. The different management choices for HCC include surgical resection, liver transplantation, local tumoral ablation, and trans-arterial chemoembolization. The combination of these different techniques can create the best results for the patients if they were selected properly. Aim of Study: To assess the role of percutaneous micro-wave ablation in the treatment of hepatocellular carcinoma and to study the effect of lesion selection on the incidence and types of complications. Material and Methods: This study was carried out on 85 cases with 100 HCC focal lesions referred for loco-regional management for single and multiple hepatocellular carcinomas, 71 males and 14 females. The age of the patients ranged from 41 to 79 years and the mean age was 61.02 years. All patients were managed by microwave ablation (MWA). Results: The present study included 85 patients with 100 lesions, all the patients were classified as BCLC, type A having single lesion or multiple (up to 3) HCC lesions. These lesions were not fit for liver transplantation or resection. The lesions were divided into two groups, the first group included non-complicated lesions (n=84) and the second group included complicated lesions (n=16). We had 14 minor complications and 2 major complications. There was significant significance (p=0.028) regarding the number of ablated HCCs between the two groups (as complications were more common when the number of lesions increased). Also, There was significant significance (p=0.04) between the two groups regarding tumors in segment III (p=0.006) and segment VI (as the location of the lesions in these sites increased the incidence of complica-tions). No statistical significance was detected between the two groups regarding age and sex. No statistical significance was detected between the two groups regarding microwave ablation watt or ablation time. No statistical significance was detected between the two groups considering the tumor size. Conclusion: MWA is an effective method for the treatment of HCC if the lesions are selected properly to achieve complete ablation and to reduce the incidence of major and minor procedural complications.