47: Surgical Microwave Ablation for Treatment of Hepatocellular Carcinoma: A Single Institution Review from 2006-2022

Saturday, March 25, 2023

10:06 AM – 10:16 AM

Location: Ballroom A

Abstract Presenter(s)

Ansley B. Ricker, MD (she/her/hers)

HPB Surgery Research Resident
Atrium Health Carolinas Medical Center
Charlotte, North Carolina, United States

Disclosure(s): No financial relationships to disclose

First Author(s)

Ansley B. Ricker, MD (she/her/hers)

HPB Surgery Research Resident
Atrium Health Carolinas Medical Center
Charlotte, North Carolina, United States

Disclosure(s): No financial relationships to disclose

Author(s)

MS

Matthew Strand, MD

HPB Surgery Research Fellow
Atrium Health Carolinas Medical Center, United States

Disclosure information not submitted.
KP

Katheryn Peterson, BSPH

HPB Surgery Research Coordinator
Atrium Health Carolinas Medical Center, United States

Disclosure information not submitted.
RM

Rohit Mantha, BS

HPB Surgery Research Associate
Atrium Health Carolinas Medical Center, United States

Disclosure information not submitted.
HW

Hannah Wang, PhD

HPB Surgery Senior Data Scientist
Atrium Health Carolinas Medical Center, United States

Disclosure information not submitted.
IM

Iain McKillop, PhD

HPB Surgery Research Professor & Director of Research
Atrium Health Carolinas Medical Center, United States

Disclosure information not submitted.
MB

Michael Beckman, MD

HPB Surgeon
Atrium Health Carolinas Medical Center, United States

Disclosure information not submitted.
MD

Michael Driedger, MD

HPB Surgeon
Atrium Health Carolinas Medical Center, United States

Disclosure information not submitted.
Erin H. Baker, MD

Assistant Professor of Surgery
Atrium Health
Charlotte, North Carolina, United States

Disclosure information not submitted.
JM

John Martinie, MD

HPB Surgeon
Atrium Health Carolinas Medical Center, United States

Disclosure information not submitted.
DV

Dionisios Vrochides, MD

HPB Surgeon
Atrium Health Carolinas Medical Center, United States

Disclosure information not submitted.
DI

David Iannitti, MD

HPB Surgeon
Atrium Health Carolinas Medical Center, United States

Disclosure information not submitted.

Disclosure(s):

Ansley B. Ricker, MD: No financial relationships to disclose

Introduction: Hepatocellular carcinoma (HCC) is a leading cause of morbidity and cancer-related mortality worldwide. Among the several locally destructive operative and procedural techniques that exist for the treatment of HCC, surgical microwave ablation (MWA) has become the preferred treatment modality because of its operative convenience, superior heating profile, reduced treatment times, and higher technical success rates. Furthermore, HCC often rises in the setting of cirrhosis, precluding resection. This study aims to analyze surgical MWA for the treatment of HCC from over a decade of experience at a large-volume HPB practice and challenge the conventional practice of only ablating HCC lesions of 3 cm or less.

Methods: After obtaining IRB approval, data for patients with HCC treated with surgical MWA was retrieved from the EMR (2006-2022). Follow-up imaging was examined to determine rates of incomplete ablation (IA), local recurrence (LR), regional recurrence (RR), and metastatic recurrence (MR). Data were analyzed via Pearson chis-square, Wilcoxon's two-sample test, Kaplna-Meier analysis, univariate analysis, and multivariate analysis.

Results: In total, 1,201 surgical MWA were performed across 1,110 patients at our institution from 2006-2022. Of these surgical MWA, 627 (52.5%) were performed across 559 patients for HCC. 78.2% of patients were male, 71% were Caucasian, and 20.6% were African American. Of the HCC ablations, 94.8% were performed laparoscopically, 1.1% hand-assisted laparoscopically, 3.0% open, and 1.1% robotically. 89.2% of patients had cirrhosis, 56.9% Hepatitis C, and 28% multifocal hepatic disease. Average MELD score for patients was 10 (6-29). Average tumor size ablated was 2.64cm (0.3-8.5). Of the ablated HCC lesions, 4.8% had IA, 14.5% LR, 44.2% RR, and 12.5% MR. Risk factors associated with recurrence in HCC following surgical MWA were Hepatitis C (65.4% vs. 52.2%, p=0.001) and previous ablation (19% vs. 9%, p=0.001). Tumor size was not a risk factor for recurrence. 1-year survival was 0.85 (95% CI 0.82-0.88), 3-year survival 0.63 (95% CI 0.59-0.67), and 5-year survival 0.53 (95% CI 0.48-0.58). Median overall survival time was 75.6 months, median follow-up 32 months, and disease-free survival 59.7 months.

Conclusions: Our data supports that surgical MWA is an acceptable treatment option for HCC despite lesion size. Given its superior operative qualities combined with our recurrence and survival rates, surgical MWA is a superior treatment option when compared to resection and other locally destructive ablative techniques in the treatment of HCC.

Learning Objectives:

List risk factors associated with recurrence for HCC following surgical microwave ablation.
Describe recurrence rates for HCC following surgical microwave ablation.
Describe survival rates for HCC following surgical microwave ablation.