Microwave ablation versus laparoscopic resection for hepatocellular carcinoma in patients with clinically significant portal hypertension: a propensity score-matched study of postoperative liver decompensation

Hongli Yu; Fenglin Zhao; Xiaoxiao Men; Huaqiang Zhu; Jingrui Yan; Zongxin Liu; Qiqi Liu; Yuemin Feng; Le Wang; Min Meng; Qiang Zhu; Xinya Zhao

doi:10.1007/s00330-023-10268-0

Microwave ablation versus laparoscopic resection for hepatocellular carcinoma in patients with clinically significant portal hypertension: a propensity score-matched study of postoperative liver decompensation

Eur Radiol. 2023 Oct 25. doi: 10.1007/s00330-023-10268-0. Online ahead of print.

Authors

Hongli Yu¹, Fenglin Zhao¹, Xiaoxiao Men¹, Huaqiang Zhu², Jingrui Yan³, Zongxin Liu¹, Qiqi Liu¹, Yuemin Feng³, Le Wang⁴, Min Meng⁵, Qiang Zhu^{6

7}, Xinya Zhao⁸

Affiliations

¹ Department of Gastroenterology, Shandong Provincial Hospital, Shandong University, 324, Jing 5 Rd, Jinan, Shandong, 250021, China.
² Department of Hepatobiliary Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, 250021, China.
³ Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, 250021, China.
⁴ Department of Geriatrics, Department of Geriatric Gastroenterology, Shandong Provincial Hospital affiliated to Shandong First Medical University, Jinan, Shandong, 250021, China.
⁵ Department of Oncology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, 250021, China.
⁶ Department of Gastroenterology, Shandong Provincial Hospital, Shandong University, 324, Jing 5 Rd, Jinan, Shandong, 250021, China. zhuqiang@sdu.edu.cn.
⁷ Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, 250021, China. zhuqiang@sdu.edu.cn.
⁸ Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, 324, Jing 5 Rd, Jinan, Shandong, 250021, China. zhaoxinya@sdfmu.edu.cn.

PMID: 37875593
DOI: 10.1007/s00330-023-10268-0

Abstract

Objectives: The study of postoperative liver decompensation after microwave ablation (MWA) for hepatocellular carcinoma (HCC) in patients with clinically significant portal hypertension (CSPH) is still lacking. The purpose of the present study was to compare the postoperative liver decompensation after MWA and laparoscopic resection (LR) for HCC in patients with CSPH.

Methods: The present retrospective study enrolled 222 HCC patients with CSPH who underwent MWA (n = 67) or LR (n = 155). Postoperative liver decompensation, complications, postoperative hospital stays, and overall survival were analyzed. Factors associated with postoperative liver decompensation were identified.

Results: After propensity score matching, the postoperative liver decompensation rate was significantly lower in the MWA group than that in the LR group (15.5% versus 32.8%, p = 0.030). The multivariable regression analysis identified that type of treatment (MWA vs. LR, odds ratio [OR] 0.44; 95% confidence interval [CI], 0.21-0.91; p = 0.026) and Child-Pugh B (OR, 2.86; 95% CI, 1.24-6.61; p = 0.014) were independent predictors for postoperative liver decompensation. The rate of complications for patients in the MWA group was significantly lower than that in the LR group (p < 0.001). And MWA showed shorter postoperative hospital stays than LR (3 days vs. 6 days, p < 0.001). Overall survival rate between the two groups was not significantly different (p = 0.163).

Conclusion: Compared with laparoscopic resection, microwave ablation has a lower rate of postoperative liver decompensation and might be a better option for HCC patients with CSPH.

Clinical relevance statement: Microwave ablation exhibited a lower incidence of postoperative liver decompensation in comparison to laparoscopic resection, thereby conferring greater advantages to hepatocellular carcinoma patients with clinically significant portal hypertension.

Key points: •Postoperative liver decompensation rate after microwave ablation was lower than that of laparoscopic resection for hepatocellular carcinoma in patients with clinically significant portal hypertension. •Microwave ablation showed shorter postoperative hospital stays than laparoscopic resection. •Microwave ablation had fewer complications than laparoscopic resection.

Keywords: Carcinoma (hepatocellular); Hypertension (portal); Laparoscopy; Microwaves.