Comparative study evaluating pain after hepatectomy versus percutaneous microwave ablation in hepatocellular carcinoma patients: retrospective analysis of a single center’s experience

Konstantinos Palialexis, Dimitrios Filippiadis, Stavros Spiliopoulos, George Velonakis, Lazaros Reppas, Elias Brountzos, Nikolaos Kelekis

Abstract


Purpose: To compare post-therapeutic pain and analgesia following surgical hepatectomy versus image-guided percutaneous microwave ablation (MWA) for the treatment of hepatocellular carcinoma (HCC).

Material and Methods: This is a retrospective, single-cener, study of 64 consecutive patients with HCC, who underwent either partial hepatectomy (Group A: 32 patients) or image-guided MWA (Group B: 32 patients) between January 2015 and January 2017.  In Group B, MWA was performed under local anaesthesia and conscious sedation. The study’s primary outcome measure was the comparison of daily pain score between the two groups, using a self-reported Numeric Visual Scale (NVS) questionnaire. Secondary outcome measure included the comparison of required analgesics (type and dose) administrated. Pain score comparison between the two groups was performed with independent samples Mann-Whitney U test.

Results: Mean pain score was significantly lower each day for Group B compared to Group A (NVS units: 1.82 ± 1.88 vs. 7.67 ± 0.88 in day 1; 0.64 ± 0.84 vs. 7.43 ± 0.93 in day 2, 0 vs. 6.97 ± 1.12 in day 3 and 0 vs. 6.35 ± 1.08 in day 4; p<0.001, respectively). In Group A, 13/32 patients (40.6%) required patient controlled analgesia (PCA) using intravenous infusion pump and 19/32 patients (59.4%) underwent epidural catheter placement. In Group B, 4/32 patients (12.5%) required minor analgesia (single intravenous dose of paracetamol) only during the first day.

Conclusions: According to the self reported pain scores, image-guided percutaneous MWA resulted in significantly less pain during the follow-up period compared to partial hepatectomy, without the need of epidural or intravenous pump analgesia. 


Keywords


pain; hepatectomy; microwave ablation; hepatocellular carcinoma

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References


EASL-EORTC clinical practice guidelines: management of hepatocellular carcinoma. european association for the study of the liver; European organization for research and treatment of cancer. J Hepatol 2012; 56(4): 908-943.

Bruix J, Reig M, Sherman M. Evidence-based diagnosis, staging, and treatment of patients with hepatocellular carcinoma. Gastroenterology 2016; 150(4): 835-853.

Ahmed M, Brace CL, Lee FT, et al. Principles of and advances in percutaneous ablation. Radiology 2011; 258(2): 351-369.

Tiong L, Maddern GJ. Systematic review and Meta-analysis of survival and disease recurrence after radiofrequency ablation for hepatocellular carcinoma. Br J Surg 2011; 98(9): 1210-1224.

Lee S, Loecher M, Iyer R. Immunomodulation in hepatocellular cancer. J Gastrointest Oncol 2018; 9(1): 208-219.

Nault JC, Sutter O, Nahon P, et al. Percutaneous treatment of hepatocellular carcinoma: State of the art and innovations. J Hepatol 2017. pii: S0168-8278(17)32351-6.

Bertot LC, Sato M, Tateishi R, et al. Mortality and complication rates of percutaneous ablative techniques for the treatment of liver tumors: a systematic review. Eur Radiol 2011; 21(12): 2584-2596.

Wah TM, Arellano RS, Gervais DA, et al. Image-guided percutaneous radiofrequency ablation and incidence of post-radiofrequency ablation syndrome: prospective survey. Radiology 2005; 237(3): 1097-1102.

Lee S, Rhim H, Kim YS, et al. Percutaneous radiofrequency ablation of hepatocellular carcinomas: factors related to intraprocedural and post-procedural pain. AJR Am JRoentgenol 2009; 192(4): 1064-1070.

Liang P, Wang Y, Yu X, et al. Malignant liver tumors: treatment with percutaneous microwave ablation-complications among cohort of 1136 patients. Radiology 2009; 251(3): 933-940.

Lubner MG, Brace CL, Hinshaw JL, et al. Microwave tumor ablation: mechanism of action, clinical results, and devices. J Vasc Interv Radiol 2010; 21 (suppl): S192-S203.

Brace CL, Hinshaw JL, Laeseke PF, et al. Pulmonary thermal ablation: comparison of radiofrequency and microwave devices by using grosspathologic and CT findings in a swine model. Radiology 2009; 251(3): 705-711.

Andreano A, Brace CL. A comparison of direct heating during radiofrequency and microwave ablation in ex vivo liver. Cardiovasc Intervent Radiol 2013; 36(2): 505-511.

Ong SL, Gravante G, Metcalfe MS, et al. Efficacy and safety of microwave ablation for primary and secondary liver malignancies: a systematic review. Eur J Gastroenterol Hepatol 2009; 21(6): 599-605.

Lorentzen T, Skjoldbye BO, Nolsoe CP. Microwave ablation of liver metastases guided by contrast-enhanced ultrasound: experience with 125 metastases in 39 patients. Ultraschall Med 2011; 32(5): 492-496.

Filippiadis DK, Spiliopoulos S, Konstantos C, et al. Computed tomography-guided percutaneous microwave ablation of hepatocellular carcinoma in challenging locations: safety and efficacy of high-power microwave platforms. Int J Hyperthermia 2018; 34(6): 863-869.

Andreano A, Galimberti S, Franza E, et al. Percutaneous microwave ablation of hepatic tumors: prospective evaluation of postablation syndrome and postprocedural pain. J Vasc Interv Radiol 2014; 25(1): 97-105.

Bismuth H. Surgical anatomy and anatomical surgery of the liver. World J Surg 1982; 6(1): 3-9.

Couinaud C. Liver anatomy: portal (and suprahepatic) or biliary segmentation. Dig Surg 1999; 16(6): 459-467.

Jin S, Fu Q, Wuyun G, et al. Management of post-hepatectomy complications. World J Gastroenterol 2013; 19(44): 7983-7991.

Vilana R, Bianchi L, Varela M, et al. Is microbubble-enhanced ultrasonography sufficient for assessment of response to percutaneous treatment in patients with early hepatocellular carcinoma? Eur Radiol 2006; 16(11): 2454-2462.

Lindsay JW, Karen RB, Jukes PN, et al. Postoperative management after hepatic resection. J Gastrointest Oncol 2012; 3(1): 41-47.

Werawatganon T, Charuluxanun S. Patient controlled intravenous opioid analgesia versus continuous epidural analgesia for pain after intra-abdominal surgery. Cochrane Database Syst Rev 2005; (1): CD004088.

C. Lentschener, Y. Ozier. Anaesthesia for elective liver resection: some points should be revisited. Eur J Anaesthesiol 2002; 19(11): 780-788.

Chandok N, Watt KDS. pain management in the cirrhotic patient: the clinical challenge. Mayo Clin Proc 2010; 85(5): 451-458.

Rudin A, Lundberg JF, Hammarlund-Udenaes M, et al. Morphine metabolism after major liver surgery. Anesth Analg 2007; 104(6): 1409-1414.

Weinberg L, Scurrah N, Gunning K, et al. Postoperative changes in prothrombin time following hepatic resection: implications for perioperative analgesia. Anaesth Intensive Care 2006; 34(4): 438-443.

Ko JS, Choi SJ, Gwak MS, et al. Intrathecal morphine combined with intravenous patient-controlled analgesia is an effective and safe method for immediate postoperative pain control in live liver donors. Liver Transpl 2009; 15(4): 381-389.

Ohmoto K, Mimura N, Iguchi Y, et al. Percutaneous microwave coagulation therapy for superficial hepatocellular carcinoma on the surface of the liver. Hepatogastroenterology 2003; 50(53): 1547-1551.

Bhardwaj N, Strickland AD, Ahmad F, et al. A comparative histological evaluation of the ablations produced by microwave, cryotherapy and radiofrequency in the liver. Pathology 2009; 41(2): 168-172.




DOI: http://dx.doi.org/10.36162/hjr.v3i3.212

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