Clinical effect analysis of laparoscopic microwave ablation for HCC ≤ 3 cm

doi:10.3877/cma.j.issn.1674-6899.2021.05.004

Abstract

Abstract:

Objective

To investigate the clinical efficacy of laparoscopic microwave ablation on hepatocellular carcinoma(HCC)≤3 cm.

Methods

Clinical data of 166 HCC patients in Department of General Surgery, The Second Affiliated Hospital, Air Force Military Medical University from Jan. 2015 to Aug. 2016 were retrospectively analyzed. According to surgical procedure, the patients were divided into laparoscopic microwave ablation group(LMWA group)and laparoscopic hepatectomy group(LH group). The clinical efficacy and safety of the two groups were compared.

Results

The operation time, intraoperative blood loss, gastrointestinal function recovery time, abdominal drainage tube removal time and postoperative hospital stay in the LMWA group were significantly shorter than those in the LH group, with statistically significant differences between groups(P<0.05). WBC, ALT, TBIL and PT in LMWA group were significantly lower than those in LH group(P<0.05), and ALB in LMWA group was significantly higher than that in LH group(P<0.05), and the difference was statistically significant. There were no significant differences in fever, abdominal bleeding, biliary leakage, perihepatic abscess, pleural effusion and abdominal effusion between the two groups(P>0.05). The overall response rate of LMWA group 1 month postoperative was 96.67%, slightly lower than that of LH group (100.00%), but the difference was not statistically significant(P>0.05). The overall survival rates at 1, 3 and 5 years after operation were 96.67%, 85.56% and 73.33% in the LMWA group and 97.37%, 86.84% and 75.00% in the LH group, respectively, with no statistical significance(P>0.05). The disease-free survival rates at 1, 3 and 5 years after operation were 93.33%, 77.78% and 54.44% in LMWA group and 94.74%, 80.26% and 56.58% in LH group, respectively, and the difference was not statistically significant(P>0.05).

Conclusions

Laparoscopic microwave ablation is safe, feasible and effective in the treatment of single hepatocellular carcinoma ≤3 cm without vascular invasion. Compared with laparoscopic hepatectomy, the short-term and long-term effects are considerable.

Key words: Primary liver cancer, Hepatocellular carcinoma, Microwave ablation therapy, Laparoscope, Hepatectomy

Yafeng Chen, Jiangbin Li, Wenjun Zhong, Rui Dong, Li Zang, Jikai Yin, Xilin Du, Jianguo Lu. Clinical effect analysis of laparoscopic microwave ablation for HCC ≤ 3 cm[J]. Chinese Journal of Laparoscopic Surgery(Electronic Edition), 2021, 14(05): 271-276.

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Figures/Tables 6

References 23

1	Bureau of Medical Administration, National Health Commission of the People′s Republic of China. Standardization for diagnosis and treatment of hepatocellular carcinoma (2019 edition)[J]. Chin J Dig Surg， 2020， 19(1): 1-20.
2	Yoshida H, Taniai N, Yoshioka M, et al. Current status of laparoscopic hepatectomy[J]. J Nippon Med Sch， 2019， 86(4): 201-206.
3	Solaini L, Bocchino A, Cucchetti A, et al. Anatomic laparoscopic liver resection in the scenario of the hepatocellular carcinoma: a systematic review and meta-analysis[J]. Journal of Laparoendoscopic & Advanced Surgical Techniques， 2020， 30(10): 1076-1081.
4	Wu D, Yang Y, Chen J, et al. Three different ways of treating primary hepatocellular carcinoma at an early stage: a prospective comparative study[J]. Gastroenterol Res Pract， 2020， 2020(12): 1-6.
5	Izzo F, Granata V, Grassi R, et al. Radiofrequency ablation and microwave ablation in liver tumors: an update[J]. Oncologist， 2019， 24(10): 990-1005.
6	Bray F, Ferlay J, Soerjomataram I, et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries[J]． CA Cancer J Clin， 2018, 68(6): 394-424.
7	Heimbach JK, Kulik LM, Finn RS, et al. AASLD guidelines for the treatment of hepatocellular carcinoma[J]. Hepatology， 2018， 67(1): 358-380.
8	Cheung TT, Dai WC, Tsang SH, et al. Pure laparoscopic hepatectomy versus open hepatectomy for hepatocellular carcinoma in 110 patients with liver cirrhosis: a propensity analysis at a single center[J]. Ann Surg， 2016， 264(4): 612-620.
9	Ratti F, Barkhatov LI, Tomassini F, et al. Learning curve of selftaught laparoscopic liver surgeons in left lateral sectionectomy: results from an international multi-institutional analysis on 245 cases[J]. Surg Endosc， 2016， 30(8): 3618-3629.
10	Glassberg MB, Ghosh S, Clymer JW, et al. Microwave ablation compared with hepatic resection for the treatment of hepatocellular carcinoma and liver metastases: a systematic review and meta-analysis[J]. World J Surg Oncol， 2019， 17(1): 98.
11	Jin T, Liu X, Dai C, et al. Beneficial impact of microwave ablation-assisted laparoscopic hepatectomy in cirrhotic hepatocellular carcinoma patients: a propensity score matching analysis[J]. Int J Hyperthermia， 2019， 36(1): 530-537.
12	European Association for the Study of the Liver. EASL clinical practice guidelines: management of hepatocellular carcinoma[J]. J Hepatol， 2018， 69(1): 182-236.
13	Ricci AD, Rizzo A, Bonucci C, et al. The (eternal) debate on microwave ablation versus radiofrequency ablation in BCLC-A hepatocellular carcinoma[J]. In Vivo， 2020， 34(6): 3421-3429.
14	Gupta P, Maralakunte M, Kumar- MP, et al. Overall survival and local recurrence following RFA, MWA, and cryoablation of very early and early HCC: a systematic review and Bayesian network meta-analysis[J]. Eur Radiol， 2021， 31(7): 5400-5408.
15	Poulou LS, Botsa E, Thanou I, et al. Percutaneous microwave ablation vs radiofrequency ablation in the treatment of hepatocellular carcinoma[J]. World J Hepatol， 2015， 7(8): 1054-1063.
16	Mori Y, Tamai H, Shingaki N, et al. Diffuse intrahepatic recurrence after percutaneous radiofrequency ablation for solitary and small hepatocellular carcinoma[J]. Hepatol Int， 2009， 3(3): 509- 515.
17	Piskin FC, Balli HT, Aikimbaev K. Safety and efficacy analysis of microwave ablation in small hepatocellular carcinomas sized below 3 cm[J]. Pol J Radiol， 2020， 85(1): 202-208.
18	Santambrogio R, Chiang J, Barabino M, et al. Comparison of laparoscopic microwave to radiofrequency ablation of small hepatocellular carcinoma (≤3 cm)[J]. Ann Surg Oncol， 2017， 24(1): 257-263.
19	Leuchte K, Staib E, Thelen M, et al. Microwave ablation enhances tumor-specific immune response in patients with hepatocellular carcinoma[J]. Cancer Immunol Immunother， 2021， 70(4): 893-907.
20	Della Corte A, Ratti F, Monfardini L, et al. Comparison between percutaneous and laparoscopic microwave ablation of hepatocellular carcinoma[J]. Int J Hyperthermia， 2020， 37(1): 542-548.
21	Eun HS, Lee BS, Kwon IS, et al. Advantages of laparoscopic radiofrequency ablation over percutaneous radiofrequency ablation in hepatocellular carcinoma[J]. Dig Dis Sci， 2017， 62(9): 2586-2600.
22	陈焕伟，罗发，刘颖，等．腹腔镜解剖性肝切除治疗位于中央部位肝癌单中心经验[J/CD]．中华腔镜外科杂志(电子版)， 2021， 14(1): 19-23.
23	Zhang M, Ma H, Zhang J, et al. Comparison of microwave ablation and hepatic resection for hepatocellular carcinoma: a meta-analysis[J]. Onco Targets Ther， 2017， 10(3): 4829-4839.

组别	例数	性别(男/女，例)	年龄(岁， ±s)	BMI(kg/m²， ±s)	直径(cm， ±s)	HBV/HCV(例)	AFP(>400/≤400 ng/ml，例)	肝功能Child-Pugh分级(A/B级，例)	ICGR 15(%， ±s)
LMWA组	90	49/41	53±14	24.0±3.9	2.6±0.3	62/13	52/38	60/30	6.8±5.7
LH组	76	42/34	49±13	23.4±2.8	2.5±0.3	54/10	40/36	50/26	5.9±4.8
统计值		χ²＝0.011	t＝1.383	t＝1.136	t＝1.132	χ²＝0.073	χ²＝0.442	χ²＝0.014	t＝1.357
P值		0.916	0.183	0.275	0.277	0.787	0.506	0.905	0.191

组别	例数	性别(男/女，例)	年龄(岁， ±s)	BMI(kg/m²， ±s)	直径(cm， ±s)	HBV/HCV(例)	AFP(>400/≤400 ng/ml，例)	肝功能Child-Pugh分级(A/B级，例)	ICGR 15(%， ±s)
LMWA组	90	49/41	53±14	24.0±3.9	2.6±0.3	62/13	52/38	60/30	6.8±5.7
LH组	76	42/34	49±13	23.4±2.8	2.5±0.3	54/10	40/36	50/26	5.9±4.8
统计值		χ²＝0.011	t＝1.383	t＝1.136	t＝1.132	χ²＝0.073	χ²＝0.442	χ²＝0.014	t＝1.357
P值		0.916	0.183	0.275	0.277	0.787	0.506	0.905	0.191

组别	例数	手术时间(min)	术中出血量(ml)	术后胃肠功能恢复时间(d)	术后腹腔引流管拔除时间(d)	术后住院时间(d)
LMWA组	90	47±10	24±10	1.2±0.4	2.0±0.5	3.9±0.7
LH组	76	75±20	58±21	1.9±0.4	3.0±0.6	5.1±0.8
t值		-6.748	-5.927	-3.031	-7.071	-5.295
P值		<0.000	<0.000	0.007	<0.000	<0.000

组别	例数	手术时间(min)	术中出血量(ml)	术后胃肠功能恢复时间(d)	术后腹腔引流管拔除时间(d)	术后住院时间(d)
LMWA组	90	47±10	24±10	1.2±0.4	2.0±0.5	3.9±0.7
LH组	76	75±20	58±21	1.9±0.4	3.0±0.6	5.1±0.8
t值		-6.748	-5.927	-3.031	-7.071	-5.295
P值		<0.000	<0.000	0.007	<0.000	<0.000

组别	例数	WBC(×10⁹/L)	ALT(U/L)	TBIL(μmol/L)	ALB(g/L)	PT(s)
LMWA组	90	0.97±0.29	90±55	23±8	33.6±1.9	12.3±1.9
LH组	76	1.22±0.26	144±88	28±10	32.6±2.2	13.0±2.0
t值		-3.033	-6.639	-3.319	5.916	-10.746
P值		0.007	<0.000	0.004	<0.000	<0.000

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