Stereotactic image‐guided microwave ablation of hepatocellular carcinoma using a computer‐assisted navigation system.

Background & Aims: Ablation plays an important role in the treatment of hepatocellular carcinoma. Because image‐guided navigation technology has recently entered the clinical setting, we aimed to analyse its safety, therapeutic and procedural efficiency. Methods: Retrospective analysis of patients treated with stereotactic image‐guided microwave ablation (SMWA) between January 2015 and December 2017. Interventions were performed using computertomography‐guidance with needle trajectory, ablation planning and automatic single‐marker patient registration. Needle placement and ablation coverage was controlled by image fusion under general anaesthesia with jet‐ventilation. Results: In total 174 ablations were performed in 88 patients during 119 interventions. Mean age was 66 (46‐84) years, 74 (84.1%) were men and 74% were Child Pugh Class A. Median tumour size was 16 (4‐45) mm, 62.2% were BCLC A. Median lateral and longitudinal error of needle placement were 3.2 (0.2‐14.1) and 1.6 (0‐15.8) mm. Median one tumour (1‐4) was ablated per session. One patient developed a Dindo IIIb (0.8%) complication, six minor complications. After re‐ablation of 12 lesions, an efficacy rate of 96.3% was achieved. Local tumour progression was 6.3% (11/174). Close proximity to major vessels was significantly correlated with local tumour progression (P < .05). Median overall follow‐up was 17.5 months after intervention and 24 months after initial diagnosis. BCLC stage, child class and previous treatment were significantly correlated with overall survival (P < .05). Conclusion: Stereotactic image‐guided microwave ablation is a safe and efficient treatment for HCC offering a curative treatment approach in general and in particular for lesions not detectable on conventional imaging or untreatable because of difficult anatomic locations. See Editorial on Page 1798 [ABSTRACT FROM AUTHOR]