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Microwave ablation of liver malignancies: comparison of effects and early outcomes of percutaneous and intraoperative approaches with different liver conditions

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Abstract

Liver thermal ablation is an alternative treatment for hepatocellular carcinoma (HCC) and secondary liver malignancies. Microwave ablation (MWA) produces large ablation zones (AZ) in short time; however, AZ prediction is based on preclinical ex vivo models, rising concerns about reproducibility and safety in humans. We aimed to investigate the effects produced by a new-generation MWA system on human liver in vivo with different approaches (percutaneous or intraoperative) and liver conditions (cirrhosis or previous chemotherapy treatment), in comparison with manufacturer-provided predictions based on ex vivo animal models. Complete tumor ablation (CA) and early clinical outcomes were also assessed. From October 2014, 60 consecutive patients (cirrhotic = 31; non-cirrhotic = 10; chemotherapy-treated = 19) with 81 liver nodules (HCC = 31; mets = 50) underwent MWA procedures (percutaneous = 30; laparotomic = 18; laparoscopic = 12), with a 2450 MHz/100 W generator with Thermosphere™ Technology (Emprint™, Medtronic). A contrast-enhanced CT or MR was performed after one month to assess CA and measure AZ. A linear correlation between AZ volumes and ablation times was observed in vivo, without differences from manufacturer-provided ex vivo predictions in all operative approaches and liver conditions. Other independent variables (sex, age, nodule location) showed no relationship when added to the model. Median (IQR) longitudinal and transverse roundness-indexes of the AZs were, respectively, 0.77(0.13) and 0.93(0.11). CA at 1 month was 93% for percutaneous and 100% for intraoperative procedures (p = 0.175). Thirty-day morbidity and mortality were 3% and 0%. MWA with Thermosphere™ Technology produces predictable AZs on human liver in vivo, according to manufacturer-provided ex vivo predictions. In our experience, this new-generation MWA system is effective and safe to treat liver malignancies in different operative and clinical settings.

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Authors and Affiliations

  1. Department of Radiology and Experimental Imaging Center, San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy

    Francesco De Cobelli, Paolo Marra, Michele Colombo, Anna Damascelli, Claudio Sallemi, Simone Gusmini, Marco Salvioni, Pietro Diana, Massimo Venturini & Alessandro Del Maschio

  2. Department of Surgery, Hepato-biliary Surgery Unit, San Raffaele Scientific Institute, Milan, Italy

    Francesca Ratti, Federica Cipriani & Luca Aldrighetti

  3. Vita-Salute San Raffaele University, Milan, Italy

    Francesco De Cobelli, Paolo Marra, Alessandro Ambrosi, Michele Colombo, Anna Damascelli, Pietro Diana, Massimo Venturini, Luca Aldrighetti & Alessandro Del Maschio

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  1. Francesco De Cobelli
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De Cobelli, F., Marra, P., Ratti, F. et al. Microwave ablation of liver malignancies: comparison of effects and early outcomes of percutaneous and intraoperative approaches with different liver conditions. Med Oncol 34, 49 (2017). https://doi.org/10.1007/s12032-017-0903-8

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