Local Anaesthesia Vs. General Anaesthesia for Percutaneous Microwave Ablation in Hepatocellular Carcinoma: Efficacy, Safety, and Cost Analysis

Overview

Journal Front Oncol

Specialty Oncology

Date 2023 Sep 29

PMID 37771440

Authors

Jing-Ying Zhan

Dan Zhao

Zhen-Lei Tang

Hao-Qun Leng

Affiliations

Soon will be listed here.

Abstract

Purpose: To compare the efficacy, safety, and cost of local anaesthesia and general anaesthesia modalities for percutaneous microwave ablation as a curative treatment for hepatocellular carcinoma patients.

Methods: This comparative, retrospective study analysed 175 patients who were treated for hepatocellular carcinoma (HCC) from July 2015 to September 2020. Conventional transcatheter arterial chemoembolization (cTACE) combined with sequential percutaneous microwave ablation (MWA) was performed on every lesion in every patient. Patients were divided into two cohorts according to the anaesthesia modality applied during MWA. To investigate the differences in efficacy between the two groups, overall survival (OS) and local recurrence-free survival (LRFS) were estimated by the Kaplan-Meier method and compared by the log-rank test. Cost and safety between the two groups were also compared accordingly.

Results: There were 105 patients with 128 HCC lesions in the local anaesthesia (LA) group and 70 patients with 107 lesions in the general anaesthesia (GA) group. There were no significant differences in OS (P = 0.798) or LRFS (P = 0.406) between the two groups. Fifty-two pairs of patients were matched with 77 lesions in the GA group and 67 lesions in the LA group after PSM. There was no significant difference in OS (P = 0.522) or LRFS (P = 0.410) between the two groups. Compared to the LA group, the GA group had longer operations, consumed more medical resources, had a heavier financial burden, and experienced more anaesthesia adverse events. There was no significant difference in the incidence of post-ablation pain (p=0.487), fever (P=0.678), nausea or vomiting (P=0.808), mild liver dysfunction (P=0.753), haemolytic uraemic syndrome (P=0.595), pleural effusion (P=0.622), liver abscess (0.544), asymptomatic perihepatic fluid (0.703) or subcapsular liver hemorrhage (P=0.666) between the two groups.

Conclusion: Due to the higher cost and adverse events of general anaesthesia, local anaesthesia may be more suitable for ablation procedures for HCC patients within the Milan criteria.

References

Gaba R, Lewandowski R, Hickey R, Baerlocher M, Cohen E, Dariushnia S . Transcatheter Therapy for Hepatic Malignancy: Standardization of Terminology and Reporting Criteria. J Vasc Interv Radiol. 2016; 27(4):457-73. DOI: 10.1016/j.jvir.2015.12.752. View

Potretzke T, Ziemlewicz T, Hinshaw J, Lubner M, Wells S, Brace C . Microwave versus Radiofrequency Ablation Treatment for Hepatocellular Carcinoma: A Comparison of Efficacy at a Single Center. J Vasc Interv Radiol. 2016; 27(5):631-8. PMC: 4842085. DOI: 10.1016/j.jvir.2016.01.136. View

Soulen M, Garcia-Monaco R . Closing the Gap in Curative Ablation of Liver Cancer. Radiology. 2021; 301(1):237-238. DOI: 10.1148/radiol.2021211204. View

Borde T, Nezami N, Laage Gaupp F, Savic L, Taddei T, Jaffe A . Optimization of the BCLC Staging System for Locoregional Therapy for Hepatocellular Carcinoma by Using Quantitative Tumor Burden Imaging Biomarkers at MRI. Radiology. 2022; 304(1):228-237. PMC: 9270683. DOI: 10.1148/radiol.212426. View

Li Z, Wang C, Li J, Liu Z, Jiao D, Han X . MR-guided microwave ablation of hepatocellular carcinoma (HCC): is general anesthesia more effective than local anesthesia?. BMC Cancer. 2021; 21(1):562. PMC: 8130145. DOI: 10.1186/s12885-021-08298-2. View

Kettenbach J, Kostler W, Rucklinger E, Gustorff B, Hupfl M, Wolf F . Percutaneous saline-enhanced radiofrequency ablation of unresectable hepatic tumors: initial experience in 26 patients. AJR Am J Roentgenol. 2003; 180(6):1537-45. DOI: 10.2214/ajr.180.6.1801537. View

Hawker G, Mian S, Kendzerska T, French M . Measures of adult pain: Visual Analog Scale for Pain (VAS Pain), Numeric Rating Scale for Pain (NRS Pain), McGill Pain Questionnaire (MPQ), Short-Form McGill Pain Questionnaire (SF-MPQ), Chronic Pain Grade Scale (CPGS), Short Form-36 Bodily Pain.... Arthritis Care Res (Hoboken). 2012; 63 Suppl 11:S240-52. DOI: 10.1002/acr.20543. View

Lee D, Lee M, Kim P, Lee Y, Park H, Lee J . Outcome of No-Touch Radiofrequency Ablation for Small Hepatocellular Carcinoma: A Multicenter Clinical Trial. Radiology. 2021; 301(1):229-236. DOI: 10.1148/radiol.2021210309. View

Cao P, Meng W, Xue G, Wang N, Li Z, Kong Y . Safety and efficacy of microwave ablation to treat pulmonary nodules under conscious analgosedation with sufentanil: A single-center clinical experience. J Cancer Res Ther. 2022; 18(2):405-410. DOI: 10.4103/jcrt.jcrt_1286_21. View

10.

Jin Q, Chen X, Zheng S . The Security Rating on Local Ablation and Interventional Therapy for Hepatocellular Carcinoma (HCC) and the Comparison among Multiple Anesthesia Methods. Anal Cell Pathol (Amst). 2019; 2019:2965173. PMC: 6399555. DOI: 10.1155/2019/2965173. View

11.

Wang X, Xie W, Gan S, Wang T, Chen X, Su D . Effects of general anesthesia versus local anesthesia in primary hepatocellular carcinoma patients presenting for thermal ablation surgery: a multiple center retrospective cohort study with propensity score matching. Ann Transl Med. 2020; 8(6):277. PMC: 7186675. DOI: 10.21037/atm.2020.03.88. View

12.

Paro A, Dalmacy D, Tslimigras D, Cloyd J, Ejaz A, Pawlik T . Association of County-Level Upward Economic Mobility with Stage at Diagnosis and Receipt of Curative-Intent Treatment among Patients with Hepatocellular Carcinoma. Ann Surg Oncol. 2022; 29(8):5177-5185. DOI: 10.1245/s10434-022-11726-7. View

13.

Han K, Kim J, Yang S, Park S, Choi H, Chun S . A Single-Center Retrospective Analysis of Periprocedural Variables Affecting Local Tumor Progression after Radiofrequency Ablation of Colorectal Cancer Liver Metastases. Radiology. 2020; 298(1):212-218. DOI: 10.1148/radiol.2020200109. View

14.

Sankar A, Johnson S, Beattie W, Tait G, Wijeysundera D . Reliability of the American Society of Anesthesiologists physical status scale in clinical practice. Br J Anaesth. 2014; 113(3):424-32. PMC: 4136425. DOI: 10.1093/bja/aeu100. View

15.

Lai R, Peng Z, Chen D, Wang X, Xing W, Zeng W . The effects of anesthetic technique on cancer recurrence in percutaneous radiofrequency ablation of small hepatocellular carcinoma. Anesth Analg. 2011; 114(2):290-6. DOI: 10.1213/ANE.0b013e318239c2e3. View

16.

Khalilzadeh O, Baerlocher M, Shyn P, Connolly B, Devane A, Morris C . Proposal of a New Adverse Event Classification by the Society of Interventional Radiology Standards of Practice Committee. J Vasc Interv Radiol. 2017; 28(10):1432-1437.e3. DOI: 10.1016/j.jvir.2017.06.019. View

17.

Lee M, Kang D, Lim H, Cho J, Sinn D, Kang T . Updated 10-year outcomes of percutaneous radiofrequency ablation as first-line therapy for single hepatocellular carcinoma < 3 cm: emphasis on association of local tumor progression and overall survival. Eur Radiol. 2020; 30(4):2391-2400. DOI: 10.1007/s00330-019-06575-0. View

18.

Lin Y, Paolucci I, OConnor C, Anderson B, Rigaud B, Fellman B . Ablative Margins of Colorectal Liver Metastases Using Deformable CT Image Registration and Autosegmentation. Radiology. 2023; 307(2):e221373. PMC: 10102669. DOI: 10.1148/radiol.221373. View

19.

Reig M, Forner A, Rimola J, Ferrer-Fabrega J, Burrel M, Garcia-Criado A . BCLC strategy for prognosis prediction and treatment recommendation: The 2022 update. J Hepatol. 2021; 76(3):681-693. PMC: 8866082. DOI: 10.1016/j.jhep.2021.11.018. View

20.

Kulik L, Heimbach J, Zaiem F, Almasri J, Prokop L, Wang Z . Therapies for patients with hepatocellular carcinoma awaiting liver transplantation: A systematic review and meta-analysis. Hepatology. 2017; 67(1):381-400. DOI: 10.1002/hep.29485. View