MR-Guided Microwave Ablation of Hepatocellular Carcinoma (HCC): Is General Anesthesia More Effective than Local Anesthesia?

Abstract BackgroundPercutaneous MR-guided MWA procedures have traditionally been performed under local anesthesia(LA) and sedation. However, pain control is often difficult to manage, especially in some cases when the tumor is large or in a specific location, such as near the abdominal wall or close to the hepatic dome. Does different anesthesia methods could lead to different clinical outcomes? This study retrospectively compared the results of general anesthesia (GA) and local anesthesia (LA) for MR-guided microwave ablation (MWA) in patients with hepatocellular carcinoma (HCC≤5.0 cm).MethodsThe results of the analysis include procedure-related complications, imaging response, and the time consumed by the two sets of procedures. According to the type of anesthesia, the Kaplan-Meier method was used to compare the local tumor progression (LTP) of two groups who underwent MR-guided MWA.ResultsAll patients achieved technical success. The mean ablation duration of each patients in the procedure of GA-group and LA-group were statistical difference(P=0.012). The both group have no difference in complications and LTP (both P＞0.05). Of note, the tumor location (challenging locations) and the number of lesions (2-3 lesions) could be the main factors affecting LTP (p = 0.000, p = 0.015). Univariate Cox proportional hazard regression indicated that using different anesthesia methods (GA and LA) were not associated with longer LTP( P = 0.632 and P = 0.633, respectively) , while tumor location (challenging locations) and the number of lesions (2-3 lesions) were all related to shorter LTP(P=0.000,P=0.020,respectively). Additionally, Multivariate Cox regression further revealed that the tumor location (regular locations) and the number of lesions (single) could independently predict better LTP (both P <0.005).ConclusionsThere could be no correlation between GA and LA for LTP after MRI-guided MWA. However, tumor in challenging location and the number of lesions (2-3 lesions) seem to be the main factors affecting LTP.