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

• Published in: European radiology Vol. 34; no. 5; pp. 3226 - 3235
• Main Authors: Yu, Hongli, Zhao, Fenglin, Men, Xiaoxiao, Zhu, Huaqiang, Yan, Jingrui, Liu, Zongxin, Liu, Qiqi, Feng, Yuemin, Wang, Le, Meng, Min, Zhu, Qiang, Zhao, Xinya
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01-05-2024; Springer Nature B.V
• Subjects: Ablation; Aged; Carcinoma, Hepatocellular - complications; Carcinoma, Hepatocellular - surgery; Clinical significance; Complications; Diagnostic Radiology; Female; Hepatobiliary-Pancreas; Hepatocellular carcinoma; Hospitals; Humans; Hypertension; Hypertension, Portal - surgery; Imaging; Internal Medicine; Interventional Radiology; Laparoscopy; Laparoscopy - methods; Length of Stay; Liver; Liver cancer; Liver Neoplasms - surgery; Male; Medicine; Medicine & Public Health; Microwave ablation; Microwaves - therapeutic use; Middle Aged; Neuroradiology; Patients; Postoperative; Postoperative Complications; Propensity Score; Radiofrequency Ablation - methods; Radiology; Regression analysis; Retrospective Studies; Statistical analysis; Survival; Treatment Outcome; Ultrasound; Hypertension (portal); Laparoscopy; Carcinoma (hepatocellular); Microwaves
• ISSN: 1432-1084; 0938-7994; 1432-1084
• DOI: 10.1007/s00330-023-10268-0

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.