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

  • Hepatobiliary-Pancreas
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Abstract

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.

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Abbreviations

AASLD:

American Association for the Study of Liver Diseases

CSPH:

Clinically significant portal hypertension

HCC:

Hepatocellular carcinoma

IQR:

Interquartile ranges

LR:

Laparoscopic resection

LTP:

Local tumor progression

MELD:

Model for end-stage liver disease

MWA:

Microwave ablation

OS:

Overall survival

PHLF:

Post-hepatectomy liver failure

PLT:

Platelet counts

PSM:

Propensity score matching

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Funding

This work was supported by grants from the National Natural Science Foundation of China (No. 82160124; 82203658; 82100641) and the Study program of Corps science and technology (No. 2022AB024), Project of Science and Technology of Xinjiang Autonomous Region (2022E02044).

Author information

Authors and Affiliations

  1. Department of Gastroenterology, Shandong Provincial Hospital, Shandong University, 324, Jing 5 Rd, Jinan, Shandong, 250021, China

    Hongli Yu, Fenglin Zhao, Xiaoxiao Men, Zongxin Liu, Qiqi Liu & Qiang Zhu

  2. Department of Hepatobiliary Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, 250021, China

    Huaqiang Zhu

  3. Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, 250021, China

    Jingrui Yan, Yuemin Feng & Qiang Zhu

  4. Department of Geriatrics, Department of Geriatric Gastroenterology, Shandong Provincial Hospital affiliated to Shandong First Medical University, Jinan, Shandong, 250021, China

    Le Wang

  5. Department of Oncology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, 250021, China

    Min Meng

  6. Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, 324, Jing 5 Rd, Jinan, Shandong, 250021, China

    Xinya Zhao

Authors
  1. Hongli Yu
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  2. Fenglin Zhao
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  3. Xiaoxiao Men
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  8. Yuemin Feng
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  9. Le Wang
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  10. Min Meng
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  11. Qiang Zhu
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Corresponding authors

Correspondence to Qiang Zhu or Xinya Zhao.

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Guarantor

The scientific guarantor of this publication is Xinya Zhao.

Conflict of interest

The authors declare no competing interests.

Statistics and biometry

Yes, we enlisted a statistical expert, Xiaoxiao Men, to carefully review the statistical methods utilized throughout this study.

Informed consent

Written informed consent was waived by the institutional review board.

Ethical approval

The study was approved by the ethical committee of Shandong Provincial Hospital.

Study subjects or cohorts overlap

None.

Methodology

• retrospective

• prognostic study

• performed at one institution

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Yu, H., Zhao, F., Men, X. et al. Microwave ablation versus laparoscopic resection for hepatocellular carcinoma in patients with clinically significant portal hypertension: a propensity score–matched study of postoperative liver decompensation. Eur Radiol (2023). https://doi.org/10.1007/s00330-023-10268-0

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  • DOI: https://doi.org/10.1007/s00330-023-10268-0

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