Stereotactic image-guided microwave ablation of hepatocellular carcinoma using a computer-assisted navigation system.
Aged
Aged, 80 and over
Carcinoma, Hepatocellular
/ diagnostic imaging
Catheter Ablation
/ methods
Female
Hepatectomy
/ methods
High-Frequency Jet Ventilation
/ methods
Humans
Liver Neoplasms
/ diagnostic imaging
Male
Microwaves
/ therapeutic use
Middle Aged
Patient Safety
Retrospective Studies
Stereotaxic Techniques
Surgery, Computer-Assisted
/ methods
Survival Analysis
Switzerland
Tomography, X-Ray Computed
Treatment Outcome
hepatocellular carcinoma
microwave ablation
navigation
stereotactic
Journal
Liver international : official journal of the International Association for the Study of the Liver
ISSN: 1478-3231
Titre abrégé: Liver Int
Pays: United States
ID NLM: 101160857
Informations de publication
Date de publication:
10 2019
10 2019
Historique:
received:
25
03
2019
revised:
20
06
2019
accepted:
26
06
2019
pubmed:
6
7
2019
medline:
22
9
2020
entrez:
6
7
2019
Statut:
ppublish
Résumé
Ablation plays an important role in the treatment of hepatocellular carcinoma. Because image-guided navigation technology has recently entered the clinical setting, we aimed to analyse its safety, therapeutic and procedural efficiency. Retrospective analysis of patients treated with stereotactic image-guided microwave ablation (SMWA) between January 2015 and December 2017. Interventions were performed using computertomography-guidance with needle trajectory, ablation planning and automatic single-marker patient registration. Needle placement and ablation coverage was controlled by image fusion under general anaesthesia with jet-ventilation. In total 174 ablations were performed in 88 patients during 119 interventions. Mean age was 66 (46-84) years, 74 (84.1%) were men and 74% were Child Pugh Class A. Median tumour size was 16 (4-45) mm, 62.2% were BCLC A. Median lateral and longitudinal error of needle placement were 3.2 (0.2-14.1) and 1.6 (0-15.8) mm. Median one tumour (1-4) was ablated per session. One patient developed a Dindo IIIb (0.8%) complication, six minor complications. After re-ablation of 12 lesions, an efficacy rate of 96.3% was achieved. Local tumour progression was 6.3% (11/174). Close proximity to major vessels was significantly correlated with local tumour progression (P < .05). Median overall follow-up was 17.5 months after intervention and 24 months after initial diagnosis. BCLC stage, child class and previous treatment were significantly correlated with overall survival (P < .05). Stereotactic image-guided microwave ablation is a safe and efficient treatment for HCC offering a curative treatment approach in general and in particular for lesions not detectable on conventional imaging or untreatable because of difficult anatomic locations.
Sections du résumé
BACKGROUND & AIMS
Ablation plays an important role in the treatment of hepatocellular carcinoma. Because image-guided navigation technology has recently entered the clinical setting, we aimed to analyse its safety, therapeutic and procedural efficiency.
METHODS
Retrospective analysis of patients treated with stereotactic image-guided microwave ablation (SMWA) between January 2015 and December 2017. Interventions were performed using computertomography-guidance with needle trajectory, ablation planning and automatic single-marker patient registration. Needle placement and ablation coverage was controlled by image fusion under general anaesthesia with jet-ventilation.
RESULTS
In total 174 ablations were performed in 88 patients during 119 interventions. Mean age was 66 (46-84) years, 74 (84.1%) were men and 74% were Child Pugh Class A. Median tumour size was 16 (4-45) mm, 62.2% were BCLC A. Median lateral and longitudinal error of needle placement were 3.2 (0.2-14.1) and 1.6 (0-15.8) mm. Median one tumour (1-4) was ablated per session. One patient developed a Dindo IIIb (0.8%) complication, six minor complications. After re-ablation of 12 lesions, an efficacy rate of 96.3% was achieved. Local tumour progression was 6.3% (11/174). Close proximity to major vessels was significantly correlated with local tumour progression (P < .05). Median overall follow-up was 17.5 months after intervention and 24 months after initial diagnosis. BCLC stage, child class and previous treatment were significantly correlated with overall survival (P < .05).
CONCLUSION
Stereotactic image-guided microwave ablation is a safe and efficient treatment for HCC offering a curative treatment approach in general and in particular for lesions not detectable on conventional imaging or untreatable because of difficult anatomic locations.
Types de publication
Journal Article
Observational Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
1975-1985Commentaires et corrections
Type : CommentIn
Informations de copyright
© 2019 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
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