Laparoscopic hepatectomy versus microwave ablation For multifocal 3-5cm hepatocellular carcinoma: a Multi-center, Real-world Study-Reference-Cited by-同舟云学术

Laparoscopic hepatectomy versus microwave ablation For multifocal 3-5cm hepatocellular carcinoma: a Multi-center, Real-world Study

Published:2024-04-09 Issue: Volume: Page:
ISSN:1743-9159
Container-title:International Journal of Surgery
language:en
Short-container-title:

Author:

Wang Zhen¹,Pang Chuan¹,Meng Qiong²,Zhang De-zhi³,Hong Zhi-xian⁴,He Guang-bin⁵,Yang Hong⁶,Xiang Bang-de⁷,Li Xiao⁸,Jiang Tian-an⁹,Li Kai¹⁰,Tang Zhe¹¹,Huang Fei¹²,Lu Man¹³,Yu Xiao-ling¹,Cheng Zhi-gang¹,Liu Fang-yi¹,Han Zhi-yu¹,Dou Jian-ping¹,Wu Song-song¹⁴,Yu Jie¹,Liang Ping¹

Affiliation:

1. Department of Interventional Ultrasound, Fifth Medical Center of Chinese PLA General Hospital, Chinese PLA Medical School, Beijing, China, 100039

2. Department of Gynecology, Jinan Zhangqiu District People’s Hospital, Jinan, China, 250200

3. Abdominal ultrasound department, the first hospital of Jilin university, Changchun, China, 130012

4. Department of Hepatobiliary Surgery, Fifth Medical Center of Chinese PLA General Hospital, Chinese PLA Medical School, Beijing, China, 100039

5. Department of Ultrasound, Xijing Hospital, the Fourth Military Medical University, Xian, China, 710032

6. Department of Ultrasound, the First Affiliated Hospital of Guangxi Medical University, Nanning, China, 530021

7. Department of Hepatobiliary Surgery, Guangxi Medical University Cancer Hospital, Nanning 530021, China

8. Department of Interventional Therapy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China,100021

9. Department of Ultrasound Medicine, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China

10. Department of Ultrasound, Guangdong Key Laboratory of Liver Disease Research, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China, 510630

11. Department of Surgery, the Fourth Affiliated Hospital, Zhejiang University School of Medicine, NO. N1, Shangcheng Road, Yiwu，P. R. China

12. Department of General Surgery, the Second Affiliated Hospital of Guangxi Medical University, Nanning, China, 530021

13. Ultrasound Medical Center, Sichuan Cancer Hospital Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China, 610041

14. Department of Ultrasonography, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China, 350001

Abstract

Background: Researches comparing laparoscopic liver resection (LLR) with microwave ablation (MWA) for 3–5 cm multifocal hepatocellular carcinoma (MFHCC) are rare. Materials and Methods: From 2008 to 2019, 666 intrahepatic tumors in 289 patients from 12 tertiary medical centres in China were included in this retrospective study. Propensity score matching (PSM) was performed to balance variables between the two treatment groups over time frames 2008-2019 and 2013-2019 to observe the potential impact of advancements in intervention techniques on overall survival (OS), disease-free progression (DFS) of patients. complications, hospitalization, and cost were compared. Results: Among 289 patients, the median age was 59 years (IQR 52-66). 2008-2019, after PSM, the median OS was 97.4 months in the LLR group and 75.2 months (95% CI 47.8-102.6) in the MWA group during a follow-up period of 39.0 months. The 1-, 3- and 5-year OS rates in the two groups were 91.8%, 72.6%, 60.7% and 96.5%, 72.8%, 62.5% (HR 1.03, 95% CI 0.62-1.69, P =0.920); The corresponding DFS rates were 75.9%, 57.2%, 46.9%, and 53.1%, 17.5%, 6.2% (HR 0.35, 95% CI 0.23-0.54, P ＜0.001). 2013-2019, the median OS time was not reached in either group during the 34.0 months of follow-up, the 1-, 3- and 5-year OS rates in the two groups were 90.2%, 67.6%, 56.7% and 96.5%, 76.7%, 69.7% (HR 1.54, 95% CI 0.79-3.01, P =0.210); The corresponding DFS rates were 69.6%, 53.9%, 43.3%, and 70.4%, 32.1%, 16.5% (HR 0.68, 95% CI 0.41-1.11, P =0.120). The incidence of major complications was similar in both groups (all P> 0.05). MWA had shorter intervention times, hospitalization, and lower costs. Conclusions: For resectable MFHCC patients, LLR is preferable due to its lower recurrence rate; For patients who do not qualify for LLR, advances in ablation technology have promoted MWA as a promising alternative.

Publisher

Ovid Technologies (Wolters Kluwer Health)