Skip to main content
SpringerLink
Log in

Efficacy and survival analysis of percutaneous radiofrequency versus microwave ablation for hepatocellular carcinoma: an egyptian multidisciplinary clinic experience

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

Hepatocellular carcinoma (HCC) is a primary tumor of the liver with poor prognosis. For early stage HCC, treatment options include surgical resection, liver transplantation, and percutaneous ablation. Percutaneous ablative techniques (radiofrequency and microwave techniques) emerged as best therapeutic options for nonsurgical patients.

Aims

We aimed to determine the safety and efficacy of radiofrequency and microwave procedures for ablation of early stage HCC lesions and prospectively follow up our patients for survival analysis.

Patients and methods

One Hundred and 11 patients with early HCC are managed in our multidisciplinary clinic using either radiofrequency or microwave ablation. Patients are assessed for efficacy and safety. Complete ablation rate, local recurrence, and overall survival analysis are compared between both procedures.

Results

Radiofrequency ablation group (n = 45) and microwave ablation group (n = 66) were nearly comparable as regards the tumor and patients characteristics. Complete ablation was achieved in 94.2 and 96.1 % of patients managed by radiofrequency and microwave ablation techniques, respectively (p value 0.6) with a low rate of minor complications (11.1 and 3.2, respectively) including subcapsular hematoma, thigh burn, abdominal wall skin burn, and pleural effusion. Ablation rates did not differ between ablated lesions ≤3 and 3–5 cm. A lower incidence of local recurrence was observed in microwave group (3.9 vs. 13.5 % in radiofrequency group, p value 0.04). No difference between both groups as regards de novo lesions, portal vein thrombosis, and abdominal lymphadenopathy. The overall actuarial probability of survival was 91.6 % at 1 year and 86.1 % at 2 years with a higher survival rates noticed in microwave group but still without significant difference (p value 0.49).

Conclusion

Radiofrequency and microwave ablations led to safe and equivalent ablation and survival rates (with superiority for microwave ablation as regards the incidence of local recurrence).

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Elbaz T, Kassas M, Esmat G (2013) Management of hepatocellular carcinoma: updated review. J Cancer Ther 4(2):536–545

    Article  Google Scholar 

  2. Esmat G, Elbaz T, Kassas M (2013) Hepatocellular carcinoma in Egypt: an updated status. Liver cancer: act today, save your life tomorrow. World Gastroenterology Organisation (WGO). WDHD 2013 Final Publication. www.wgofoundation.org/WDHD-2013-Final-Publication.pdf

  3. Bruix J, Sherman M (2005) Management of hepatocellular carcinoma. Hepatology 42:1208–1236

    Article  PubMed  Google Scholar 

  4. Yao FY, Bass NM, Nikolai B, Davern TJ, Kerlan R, Wu V, Ascher NL, Roberts JP (2002) Liver transplantation for hepatocellular carcinoma: analysis of survival according to the intention-to-treat principle and dropout from the waiting list. Liver Transplant 8:873–883

    Article  Google Scholar 

  5. Llovet JM, Fuster J, Bruix J (1999) Intention-to-treat analysis of surgical treatment for early hepatocellular carcinoma: resection versus transplantation. Hepatology 30:1434–1440

    Article  CAS  PubMed  Google Scholar 

  6. Crocetti L, Lencioni R (2008) Thermal ablation of hepatocellular carcinoma. Cancer Imaging 8(1):19–26

    Article  PubMed Central  PubMed  Google Scholar 

  7. Lin S-M, Lin D-Y (2003) Percutaneous local ablation therapy in small hepatocellular carcinoma. Chang Gung Med J 26:308–314

    PubMed  Google Scholar 

  8. Kuang M, Xie XY, Huang C, Wang Y, Lin MX, Xu ZF, Liu GJ, Lu MD (2011) Long-term outcome of percutaneous ablation in very early-stage hepatocellular carcinoma. J Gastrointest Surg 15(12):2165–2171

    Article  PubMed  Google Scholar 

  9. Shiina S, Tateishi R, Arano T, Uchino K, Enooku K, Nakagawa H, Asaoka Y, Sato T, Masuzaki R, Kondo Y, Goto T, Yoshida H, Omata M, Koike K (2012) Radiofrequency ablation for hepatocellular carcinoma: 10-year outcome and prognostic factors. Am J Gastroenterol 107(4):569–577

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  10. Rossi S, Fornari F, Buscarini L (1993) Percutaneous ultrasound-guided radio-frequency electrocautery for the treatment of small hepatocellular carcinoma. J Interv Radiol 8:97–103

    Google Scholar 

  11. Salhab M, Canelo R (2011) An overview of evidence-based management of hepatocellular carcinoma: a meta-analysis. J Cancer Res Ther 7(4):463–475

    Article  CAS  PubMed  Google Scholar 

  12. Tiong L, Maddern GJ (2011) Systematic review and meta-analysis of survival and disease recurrence after radiofrequency ablation for hepatocellular carcinoma. Br J Surg 98(9):1210–1224

    Article  CAS  PubMed  Google Scholar 

  13. Poggi G, Montagna B, DI Cesare P, Riva G, Bernardo G, Mazzucco M, Riccardi A (2013) Microwave ablation of hepatocellular carcinoma using a new percutaneous device: preliminary results. Anticancer Res 33(3):1221–1227

    PubMed  Google Scholar 

  14. Bruix J, Sherman M, Llovet JM (2001) EASL Panel of Experts on HCC. Clinical management of hepatocellular carcinoma. Conclusions of the Barcelona-2000 EASL conference. European Association for the Study of the Liver. J Hepatol 35(3):421–430

    Article  CAS  PubMed  Google Scholar 

  15. Bruix J, Sherman M (2011) American Association for the Study of Liver Diseases. Management of hepatocellular carcinoma: an update. Hepatology 53(3):1020–1022

    Article  PubMed Central  PubMed  Google Scholar 

  16. Llovet JM, Bustamante J, Castells A, Vilana R, Ayuso Mdel C, Sala M, Brú C, Rodés J, Bruix J (1999) Natural history of untreated nonsurgical hepatocellular carcinoma: rationale for the design and evaluation of therapeutic trials. Hepatology 29(1):62–67

    Article  CAS  PubMed  Google Scholar 

  17. Suresh K (2011) An overview of randomization techniques: an unbiased assessment of outcome in clinical research. J Hum Reprod Sci 4(1):8–11

    Article  PubMed Central  PubMed  Google Scholar 

  18. Portmann BC (2000) Anatomy of the normal liver: Comprehensive clinical hepatology. O’Grady J, Lake J, Howdle P, 1st edn: London, Edinburgh, New York, Philadelphia, Sydney and Toronto. Chap.1. P1.1

  19. Ohmoto K, Yoshioka N, Tomiyama Y, Shibata N, Kawase T, Yoshida K, Kuboki M, Yamamoto S (2009) Comparison of therapeutic effects between radiofrequency ablation and percutaneous microwave coagulation therapy for small hepatocellular carcinomas. J Gastroenterol Hepatol 24(2):223–227

    Article  PubMed  Google Scholar 

  20. Bertot LC, Sato M, Tateishi R, Yoshida H, Koike K (2011) Mortality and complication rates of percutaneous ablative techniques for the treatment of liver tumors: a systematic review. Eur Radiol 21(12):2584–2596

    Article  PubMed  Google Scholar 

  21. Lu MD, Xu HX, Xie XY, Yin XY, Chen JW, Kuang M, Xu ZF, Liu GJ, Zheng YL (2005) Percutaneous microwave and radiofrequency ablation for hepatocellular carcinoma: a retrospective comparative study. J Gastroenterol 40(11):1054–1060

    Article  PubMed  Google Scholar 

  22. Signoriello S, Annunziata A, Lama N, Signoriello G, Chiodini P, De Sio I, Daniele B, Di Costanzo GG, Calise F, Olivieri G, Castaldo V, Lanzetta R, Piai G, Marone G, Visconti M, Fusco M, Di Maio M, Perrone F, Gallo C, Gaeta GB (2012) Survival after locoregional treatments for hepatocellular carcinoma: a cohort study in real-world patients. Sci World J 2012:564706

    Article  Google Scholar 

  23. Qian GJ, Wang N, Shen Q, Sheng YH, Zhao JQ, Kuang M, Liu GJ, Wu MC (2012) Efficacy of microwave versus radiofrequency ablation for treatment of small hepatocellular carcinoma: experimental and clinical studies. Eur Radiol 22(9):1983–1990

    Article  PubMed  Google Scholar 

  24. Lencioni R, Crocetti L (2012) Local-Regional Treatment of Hepatocellular Carcinoma. Radiology 262:43–58

    Article  PubMed  Google Scholar 

  25. Boss A, Dupuy D, Pereira PL (2008) Microwave. In: Vogl TJ, Helmberger TK, Mack MG, Reiser MF (eds) Percutaneous tumor ablation in medical radiology, 1st edn. Springer, Berlin, pp 21–28

    Chapter  Google Scholar 

  26. Simon CJ, Dupuy DE, Mayo-Smith WW (2005) Microwave ablation: principles and applications. Radiographics 25(1):S69–S83

    Article  PubMed  Google Scholar 

  27. Lu DS, Yu NC, Raman SS, Limanond P, Lassman C, Murray K, Tong MJ, Amado RG, Busuttil RW (2005) Radiofrequency ablation of hepatocellular carcinoma: treatment success as defined by histologic examination of the explanted liver. Radiology 234(3):954–960

    Article  PubMed  Google Scholar 

  28. Yu NC, Raman SS, Kim YJ, Lassman C, Chang X, Lu DS (2008) Microwave liver ablation: influence of hepatic vein size on heat-sink effect in a porcine model. J Vasc Interv Radiol 19(7):1087–1092

    Article  PubMed  Google Scholar 

  29. Yin XY, Xie XY, Lu MD, Xu HX, Xu ZF, Kuang M, Liu GJ, Liang JY, Lau WY (2009) Percutaneous thermal ablation of medium and large hepatocellular carcinoma: long-term outcome and prognostic factors. Cancer 115(9):1914–1923

    Article  CAS  PubMed  Google Scholar 

  30. Livraghi T, Meloni F, Solbiati L, Zanus G (2012) Collaborative Italian Group using AMICA system. Complications of microwave ablation for liver tumors: results of a multicenter study. Cardiovasc Intervent Radiol 35(4):868–874

    Article  PubMed  Google Scholar 

Download references

Disclosure

Drs. Ashraf Omar Abdelaziz, Tamer Mahmoud Elbaz, Sherif Hamdy Mahmoud, Hend Ibrahim Shousha, Mostafa Mohamed Ibrahim, Ahmed Hosni Abdelmaksoud, and Mohamed Mahmoud Nabeel) have any conflicts of interest to disclose. No financial or any other support was supplied by any other party.

Author information

Authors and Affiliations

  1. Endemic Hepatogastroenterology Department, Faculty of Medicine, Kasr Al Ainy Hospital, Cairo University, Cairo, 11562, Egypt

    Ashraf Abdelaziz, Tamer Elbaz, Hend Ibrahim Shousha, Sherif Mahmoud, Mostafa Ibrahim & Mohamed Nabeel

  2. Diagnostic and Interventional Radiology Department, Cairo University, Cairo, Egypt

    Ahmed Abdelmaksoud

Authors
  1. Ashraf Abdelaziz
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Tamer Elbaz
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Hend Ibrahim Shousha
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Sherif Mahmoud
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Mostafa Ibrahim
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Ahmed Abdelmaksoud
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Mohamed Nabeel
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Hend Ibrahim Shousha.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Abdelaziz, A., Elbaz, T., Shousha, H.I. et al. Efficacy and survival analysis of percutaneous radiofrequency versus microwave ablation for hepatocellular carcinoma: an egyptian multidisciplinary clinic experience. Surg Endosc 28, 3429–3434 (2014). https://doi.org/10.1007/s00464-014-3617-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-014-3617-4

Keywords

Search

Navigation