Clinical efficacy and safety of percutaneous microwave ablation in treatment of hepatocellular carcinoma

Objective: To evaluate the clinical efficacy and safety of microwave ablation (MWA) in the resection of hepatocellular carcinoma. Methods: Clinical data of 168 patients with hepatocellular carcinoma (HCC) adjacent to the gallbladder (less than 1.0 cm) undergoing ultrasonography-guided percutaneous MW ablation were retrospectively analyzed. Among them, 162 patients underwent MW ablation combined with percutaneous ethanol injection (PEI). One or two microwave cooled-shaft microwave antenna were inserted and placed at designated places in the tumor. One or two 21G PTC needles were placed into the tumor abut to gallbladder. 0.5-8 mL of absolute ethanol was injected into the tumor at the same time as microwave emission. A thermocouple was placed in 163 patients to monitor the temperature during ablation to avoid thermal injury. The safety and therapeutic efficacy of the procedures were assessed with clinical and imaging follow-up examinations. Follow-up by using the contrast-enhanced US from one to two days after therapy and contrast material-enhanced computed tomography (CT) or magnetic resonance (MR) imaging at 1 and 3 months after MW ablation and then at 3-6 months intervals. Results: No more than two sessions were performed to complete the treatment in all patients, (one session for 150 patients, two sessions for 18). The primary technique effectiveness rate was 96.5% based on one-month follow-up CT or MRI imaging (170 sessions 6). PEI or other therapies were performed to incompletely treated patients. In a median follow up of 30.1 months (range 4 to 68 months), no major complications occurred. There were no treatment-related deaths and no major complications such as cholecystitis or gallbladder perforation in the patients. Thirty-one patients (18.5%) died of progression of primary disease not directly attributable to MW ablation. Local tumor progression was noted in 5 patients (3%) completely ablated tumors during the follow-up period. More therapies were performed to local progressed tumors. Conclusion: Ultrasound-guided percutaneous microwave ablation combining with percutaneous ethanol injection and thermal monitoring is a safe and effective treatment of hepatocellular carcinoma.