Document Type: Research Articles
Department of Endemic Medicine, Faculty of Medicine, Cairo University, Cairo, Egypt.
Department of Internal Medicine, National Research Center, Cairo, Egypt.
Department of Pathology, Thedor Bilharz Research Institute, Giza, Egypt.
Background and aim: Imaging guided microwave ablation (MWA) for hepatocellular carcinoma (HCC) has
become a widely used method over recent years. Tumors close to the diaphragm, gastrointestinal tract, gallbladder,
pancreas, hepatic hilum and major bile duct or vessels are generally considered relative contraindications for microwave
ablation. This study was conducted to assess the effectiveness and safety of ultrasonography-guided MWA in treating
patients with HCC in difficult anatomical sites in comparison to those in conventional sites. Patients and methods:
Eighty-eight patients were included and divided into two groups: the study group of 44 with 46 lesions lying <5mm
from the diaphragm, hepatic capsule, gall bladder (GB) or large vessel; and the control group of 44 patients with
50 lesions in non-risky sites. Each lesion was ablated using an ultrasound guided microwave probe using a detailed
protocol. Results: Most of the patients were males, with a mean age of 57.8 years. In the study group, two patients
had lesions adjacent to the GB, twelve were perivascular and 32 were subcapsular. The overall successful ablation
rates were 84.8% and 92% in the study and control groups, respectively. Within the study group, ablation rates were
100%, 75% and 87.5% for lesions close to the GB, perivascular lesions and subcapsular lesions, respectively. One
patient developed a subcutaneous abscess, with good outcome after proper treatment. Fever, pain and asymptomatic
pleural effusion were reported after ablation without statistically significant difference between the groups or among
subgroups. In conclusion: MWA for HCC in difficult anatomical sites is as effective and safe as for ordinary sites.