Stereotactic image-guided microwave ablation of hepatocellular carcinoma using a computer-assisted navigation system

Liver Int. 2019 Oct;39(10):1975-1985. doi: 10.1111/liv.14187. Epub 2019 Jul 28.


Background & aims: Ablation plays an important role in the treatment of hepatocellular carcinoma. Because image-guided navigation technology has recently entered the clinical setting, we aimed to analyse its safety, therapeutic and procedural efficiency.

Methods: Retrospective analysis of patients treated with stereotactic image-guided microwave ablation (SMWA) between January 2015 and December 2017. Interventions were performed using computertomography-guidance with needle trajectory, ablation planning and automatic single-marker patient registration. Needle placement and ablation coverage was controlled by image fusion under general anaesthesia with jet-ventilation.

Results: In total 174 ablations were performed in 88 patients during 119 interventions. Mean age was 66 (46-84) years, 74 (84.1%) were men and 74% were Child Pugh Class A. Median tumour size was 16 (4-45) mm, 62.2% were BCLC A. Median lateral and longitudinal error of needle placement were 3.2 (0.2-14.1) and 1.6 (0-15.8) mm. Median one tumour (1-4) was ablated per session. One patient developed a Dindo IIIb (0.8%) complication, six minor complications. After re-ablation of 12 lesions, an efficacy rate of 96.3% was achieved. Local tumour progression was 6.3% (11/174). Close proximity to major vessels was significantly correlated with local tumour progression (P < .05). Median overall follow-up was 17.5 months after intervention and 24 months after initial diagnosis. BCLC stage, child class and previous treatment were significantly correlated with overall survival (P < .05).

Conclusion: Stereotactic image-guided microwave ablation is a safe and efficient treatment for HCC offering a curative treatment approach in general and in particular for lesions not detectable on conventional imaging or untreatable because of difficult anatomic locations.

Keywords: hepatocellular carcinoma; microwave ablation; navigation; stereotactic.

Publication types

  • Observational Study

MeSH terms

  • Aged
  • Aged, 80 and over
  • Carcinoma, Hepatocellular / diagnostic imaging
  • Carcinoma, Hepatocellular / mortality
  • Carcinoma, Hepatocellular / surgery*
  • Catheter Ablation / methods*
  • Female
  • Hepatectomy / methods
  • High-Frequency Jet Ventilation / methods
  • Humans
  • Liver Neoplasms / diagnostic imaging
  • Liver Neoplasms / mortality
  • Liver Neoplasms / surgery*
  • Male
  • Microwaves / therapeutic use
  • Middle Aged
  • Patient Safety
  • Retrospective Studies
  • Stereotaxic Techniques
  • Surgery, Computer-Assisted / methods*
  • Survival Analysis
  • Switzerland
  • Tomography, X-Ray Computed*
  • Treatment Outcome