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Intra-Operative Microwave Ablation of Liver Malignancies With Tumor Permittivity Feedback Control: A Prospective Ablate and Resect Study
*Linda Ratanaprasatporn1, *Damian Dupuy1,2, *Murray Resnick1,3, *Shaolei Lu1,3, Kevin Charpentier1,4 1Alpert Medical School at Brown University, Providence, RI;2Rhode Island Hospital, Department of Radiology, Providence, RI;3Rhode Island Hospital, Department of Pathology, Providence, RI;4Rhode Island Hospital, Department of Surgery, Providence, RI
Objective: Tumor permittivity feedback control is a novel method for microwave ablation that theoretically allows for larger, more predictable ablations with less susceptibility to heat-sink. Our study evaluates the safety and efficacy of microwave ablation (MWA) of liver malignancies using a device with tumor permittivity feedback control. Design: Prospective case series. Setting: Academic, tertiary care hospital. Patients: 10 consecutive patients with resectable liver malignancies measuring <5 cm who consented to the study. Interventions: Patients initially determined to be candidates for surgical resection of a liver malignancy underwent intra-operative MWA with tumor permittivity feedback control followed by surgical resection. A 14-guage Medwaves (San Diego, CA) microwave antenna was used to deliver a single treatment based on the manufacturers guidelines. The antennae tract was resected with the tumor in all cases. Tumors were assessed by gross evaluation as well as by H+E and tetrazolium chloride staining Main Outcome Measures: The primary end point was percent tumor necrosis. Complications of the procedure served as a secondary endpoint. Results: Mean maximum ablation diameter measured 2.87 cm (range 1.1-6.8 cm) with a volume of 9.83 cm3 (range 4.84-17.55 cm3). Six of ten tumors demonstrated a pathological complete response (CR). Six of seven tumors ≤3 cm demonstrated a pathologic CR. Zero of the three tumors ≥3 cm had a pathologic CR, but all had ≥50% tumor necrosis. All patients survived and there were no ablation related morbidities. Conclusions: MWA of liver tumors with tumor permittivity feedback control appears safe. MWA with tumor permittivity feedback is extremely effective for the treatment of small (<3cm) liver tumors using a single antennae, single application treatment.
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