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Laparoscopic Microwave Ablation (MWA) Is an Efficacious, Novel Modality in the Treatment of Hepatic Adenomas
Ramanathan Seshadri*1, Russell C. Kirks1, Ryan Z. Swan1, John B. Martinie1, David a. Iannitti1, Mark W. Russo2, David Sindram1
1HPB surgery, Carolinas Medical Center, Charlotte, NC; 2Hepatology, Carolinas Medical Center, Charlotte, NC
Introduction: Conventional treatment for symptomatic and large hepatic adenomas is resection. There is significant morbidity and mortality associated with major hepatic resections. We hypothesize that MWA is equally efficacious in treating hepatic adenomas, with a reduced risk profile.
Methods: A single center retrospective analysis was performed from 2007 - 2013. A total of 134 patients were identified with benign hepatic lesions. 34 patients had hepatic adenomas of which 25 were symptomatic (pain/compression of surrounding structures/bleeding) and required surgical intervention. They were subdivided into 2 groups based on clinical presentation, either intact or ruptured. Size of lesion, operative time, intraoperative blood loss and length of stay were compared between groups using paired t-test. 1 year follow-up CT or MRI was reviewed for patients who underwent MWA to assess for disease recurrence.
Results: All patients were female, median age was 36.5 (20-49). 9 patients were treated with MWA and 17 had a resection. Length of stay (days), operative time (min), and blood loss (cc) were analyzed (See Table). Smaller lesions were favored for microwave ablation. There was no evidence of recurrence on 1 year follow-up imaging.
Conclusion: Laparoscopic microwave ablation is an efficacious mode of treatment in select patients with hepatic adenomata (intact or ruptured), with a reduced risk profile and better resource utilization. Laparoscopic microwave ablation could be considered as an alternative to resection, when feasible. Results | Hepatic Adenoma | MWA | Resection | p value (* < 0.05) | | Intact | 8 | 12 | | | Ruptured | 1 | 5 | | | | | | | Number of lesions | 10 | 20 | | | Size of lesion (cm) | 4.1 | 7.3 | 0.014* | | Operative time (min) | 98 | 145 | 0.064 | | Intraoperative blood loss (cc) | 70.6 | 830 | 0.029* | | Length of stay (days) | 1.4 | 7.4 | 0.038* |
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