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Intraoperative Triple Antenna Hepatic Microwave Ablation

¹ Department of Diagnostic Imaging, Brown Medical School, Rhode Island Hospital, 593 Eddy St., Providence, RI 02903.
² Department of Surgery, Brown Medical School, Rhode Island Hospital, Providence, RI.
³ Department of Diagnostic Imaging, David Geffen School of Medicine at UCLA, Los Angeles, CA.
⁴ Department of Pathology, Brown Medical School, Rhode Island Hospital, Providence, RI.
⁵ Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA.
⁶ Department of Pathology, David Geffen School of Medicine at UCLA, Los Angeles, CA.

OBJECTIVE. Microwave ablation is emerging as a new treatment option for patients with unresectable hepatic malignancies. This two-center study shows the results of a phase 1 clinical trial of patients with known hepatic masses who underwent synchronous triple antenna microwave ablation before elective hepatic resection.

SUBJECTS AND METHODS. Intraoperative microwave ablation was performed before hepatic resection. Hepatic lesions were targeted using real-time intraoperative sonography with three microwave antennas positioned in a triangular configuration. Microwave ablation was performed at 45 W for 10 minutes. Hepatic resection was then completed in the standard fashion. Gross specimens were sectioned and measured to determine tumor and ablation sizes. Representative areas were stained with H and E stain and vital histochemical nicotinamide adenine dinucleotide (NADH) stain.

RESULTS. Ten patients with a mean age of 64 years (range, 48-79 years) were treated. Tumor histology included colorectal carcinoma metastases and hepatocellular carcinoma. The mean maximal tumor diameter was 4.4 cm (range, 2.0-5.7 cm). The mean maximal ablation diameter was 5.5 cm (range, 5.0-6.5 cm), while the average ablation zone volume was 50.8 cm³ (range, 30.3-65.5 cm³). Gross and microscopic examinations of areas after microwave ablation showed clear coagulation necrosis, even surrounding large hepatic vessels (> 3 mm in diameter). A marked thermallike effect was observed with maximal intensity closest to the antenna sites. NADH staining confirmed the uniform absence of viable tumor in the ablation zone.

CONCLUSION. This study shows the feasibility of using multiple microwave antennas simultaneously in the treatment of liver tumors intraoperatively. Additional percutaneous studies are currently under way to investigate the safety and efficacy in treating nonsurgical candidates.

Keywords: liver metastases • microwave ablation • radiofrequency ablation • radiologic-pathologic correlation

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