Laparoscopic Microwave Ablation Versus Percutaneous Microwave Ablation Of Hepatic Malignancies: Efficacy And Recurrence-free Survival Outcomes In Patients
*Joslin R Musick, *Prejesh Philips, *Charles R Scoggins, *Michael E Egger, Kelly M McMasters, Robert CG Martin
University of Louisville, Louisville, KY
Objective: Hepatic thermal ablation has been found to be effective and equivalent to resection in certain liver histology’s. Currently of the 16,000 annual liver ablations preformed in the US, 50% (7980 ablations) are performed in interventional radiology with only 13% (2080 ablations) preformed laparoscopically. The laparoscopic technique remains poor trained and thus under-utilized even with the benefits of improved staging and for better access to tumors that are difficult to reach percutaneously. The purpose of this study is to compare laparoscopic MWA (LMWA) versus percutaneous MWA (PMWA) in terms of efficacy and recurrence-free survival outcomes in patients with hepatic malignancies.Methods: A comparative analysis was performed on 275 patients (289 ablation procedures) who underwent LMWA or PMWA between February 2011 and May 2021. Ablation success was confirmed post-procedure and recurrence (local and intra-hepatic) was monitored at follow-up via contrast-enhanced CT/MRI and/or CT/PET. Results: The groups were similar for gender, age, BMI, location of tumor, size of tumor, and # of tumors. Median length of stay was 23 hours for both groups and ablation success was 100% in both groups. Local recurrence was significant(5%:LMWA vs 22%:PMWA, p=0.002)and same-lobe recurrence(21%LMWA vs 25%PMWA) was lower in the LMWA group. Contralateral lobe recurrence was higher in the LMWA group(17%) compared to the PMWA group(11%) (P=0.3)). Median recurrence-free survival was 15.8 months for the LMWA group and 5.6 months for the PMWA group(P = 0.0002). Overall 90 day vomplications were lower in the LMWA group(11%) compared to the PMWA group (21%) (P = 0.11), with improvement in the 90 day mortality as well(0.6% vs 3%). Conclusions: Laparoscopic surgical ablation is a critical surgical skill that must be taught in fellowship. LMWA lead to better tumor specific outcomes(recurrence) and oncologic outcomes(RFS and Mortality) demonstrating clinically efficacy in the minimally invasive treatment of hepatic malignancies compared to PMWA..
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