Abstract Objectives To compare technical/clinical outcomes of microwave ablations (MWA) for hepatocellular carcinoma (HCC) performed with percutaneous ultrasound (US)-guidance, intraoperative ultrasound (IOUS)-guidance or CT hepatic arteriography (CTHA)-guidance. Materials & methods This single-center retrospective study included 111 non-randomized patients (M:F = 91:20, median age 66y, range 51–86) with 200 HCCs (BCLC 0-A-B), treated with 136 MWA procedures (66 US-guided, 36 IOUS-guided, 34 CTHA-guided) between July 1, 2017, and January 31, 2025, with at least 6 months of clinical and CT/MRI follow-up. We evaluated patients’ and nodules’ characteristics, radicality (absent residual tumor at follow-up), local tumor progression, additional treatments, adverse events (CIRSE classification) and mortality. For patients undergoing multiple ablations, clinical outcomes were analyzed in relation to the first treatment. Results One nodule was ablated in 94/136 (69.1%) procedures, 2 nodules in 25/136 (18.4%), > 3 in 17/136 (12.5%). We encountered 13 adverse events, with the highest severity in IOUS-guided MWAs (1 grade 3, 2 grade 6). Fifty-eight patients (52.3%) progressed in other segments, subsequent treatments were performed in 57/111 (51.3%) patients and 28/111 (25.2%) died during follow-up. IOUS-guided MWA was associated with the highest radicality rate (56/60, 93.3%, p = 0.04) compared to CTHA-guided (45/51, 88.2%) and US-guided (72/89, 80.9%) ablations. Treating multiple nodules increased complication risk ( p = 0.003), impacting on radicality ( p = 0.032). No differences were found for overall survival ( p = 0.07) or progression-free survival ( p = 0.584) among the techniques. Conclusions IOUS-guidance for HCC ablation provided a higher radicality rate compared to CTHA- and ultrasound-guidance techniques, but carried a higher risk of severe complications.
Muglia et al. (Tue,) studied this question.