Liver and Bile
Hepatology. 2022;76(1):66–77
Microwave ablation versus laparoscopic resection as first-line therapy for solitary 3–5-cm HCC
Background and aims: The study objective was to compare the effectiveness of microwave ablation (MWA) and laparoscopic liver resection (LLR) on solitary 3–5-cm hepatocellular carcinoma (HCC) over time.
Approach and results: From 2008 to 2019, 1289 patients from 12 hospitals were enrolled in this retrospective study. Diagnosis of all lesions were based on histopathology. Propensity score matching was used to balance all baseline variables between the 2 groups in 2008–2019 (n = 335 in each group) and 2014–2019 (n = 257 in each group) cohorts, respectively. For cohort 2008–2019, during a median follow-up of 35.8 months, there were no differences in overall survival (OS) between MWA and LLR (hazard ratio [HR] = 0.88, 95% confidence interval [CI]: 0.65–1.19; p = 0.420), and MWA was inferior to LLR regarding disease-free survival (DFS) (HR = 1.36, 95% CI: 1.05–1.75; p = 0.017). For cohort 2014–2019, there was comparable OS (HR = 0.85, 95% CI: 0.56–1.30; p = 0.460) and approached statistical significance for DFS (HR = 1.33, 95% CI: 0.98–1.82; p = 0.071) between MWA and LLR. Subgroup analyses showed comparable OS in 3.1–4-cm HCCs (HR = 0.88, 95% CI: 0.53–1.47; p = 0.630) and 4.1–5-cm HCCs (HR = 0.77, 95% CI: 0.37–1.60; p = 0.483) between 2 modalities. For both cohorts, MWA shared comparable major complications (both p > 0.05), shorter hospitalization, and lower cost to LLR (all p < 0.001).
Conclusions: Microwave ablation might be a first-line alternative to laparoscopic liver resection (LLR) for solitary 3–5-cm hepatocellular carcinoma in selected patients with technical advances, especially for patients unsuitable for LLR.
DOI: 10.1002/hep.32323