Clinical efficacy of MWA via the caudal‒cranial direction puncture pathway for small hepatocellular carcinoma at the hepatic dome: 3 years of follow-up

To evaluate the clinical efficacy of microwave ablation (MWA) for small hepatocellular carcinoma (HCC) located at the hepatic dome via the caudal‒cranial direction puncture pathway(CCDPP) within the coronal or sagittal plane under computed tomography (CT) guidance. A retrospective analysis was conducted to analyze data from 29 patients with HCC located at the hepatic dome who underwent CT-guided MWA from March 2019 to November 2024. The puncture path of the microwave antenna during ablation is from caudal to cranial direction within the coronal or sagittal planes reconstructed via multislice spiral CT. Baseline patient data were collected, and outcomes, including the puncture technique success rate, ablation success rate, and incidence of complications, etc., were observed. Kaplan‒Meier survival curve analysis was used to calculate the disease-free survival (DFS) and overall survival (OS) rates of all patients. A total of 29 lesions in 29 patients were ablated and the mean timor size is 25.5 ± 11.0 mm. The puncture technique success rate and ablation success rates were both 100%, and no serious complications occurred. One month post-MWA, enhanced abdominal CT or MRI scans revealed complete ablation in 96.6% of all patients, whereas 3.4% (1/29) had incomplete ablation, necessitating additional MWA treatment. By the cutoff of follow-up, the mean follow-up time for all patients was 26.03 ± 17.98 months. The local tumor progression rate was 17.2%, and the 1-, 2-, and 3-year disease-free survival rates were 88.1%, 74.2%, and 74.2%, respectively. The 1-, 2-, and 3-year overall survival rates were 91.8%, 72.4%, and 72.4%, respectively. Further subgroup analysis did not find any statistically significant differences whether administrating TACE before ablation or not and the distance between the tumor and the diaphragm less than 5 mm or not. Microwave ablation with the CCDPP used in the puncture process could be preliminarily revealed to be safe, feasible, and effective, with acceptable oncological midterm outcomes for the treatment of small HCC lesions in the hepatic dome. Further research is warranted.