ORIGINAL RESEARCH Percutaneous Microwave Ablation Under CT Guidance for Hepatocellular Carcinoma: a Single Institutional Experience Claudio Pusceddu 1 & Luca Melis 1 & Nicola Ballicu 1 & Barbara Sotgia 1 & Marcovalerio Melis 2 & Valeria Sanna 3 & Giovanni Battista Meloni 4 & Alberto Porcu 5 & Alessandro Fancellu 5 Published online: 22 May 2017 # Springer Science+Business Media New York 2017 Abstract Background Microwave ablation (MWA) is an emerging treatment for treatment of patients with hepatocellular carci- noma (HCC) not amenable of surgical resection. Patients and Methods We searched for patients diagnosed as having small-, medium-, and large HCCs treated with MWA under CT guidance between 2010 and 2014. The main out- comes of interest were rates of complete ablation, complica- tions, and overall survival. Rates of complete ablation were compared with Chi-square test, and estimated survival rates were calculated by means of Kaplan-Meier method. Results Thirty-two patients with 45 HCC nodules received MWA. Seventeen (37.8%) nodules were <3 cm (small), 15 (33.3%) between 3 and 5 cm (medium), and 13 (28.9%) > 5 cm (large). Complete ablation was obtained in 94.1% of small tumors, 80% of medium tumors, and 53.8% of large tumors (p = 0.03). Two patients had HCC located in risk area (paracardiac position). Minor complica- tions occurred after seven procedures (15.5%). Estimated median survival was 37 months (95% confidence interval 11.97–62.02). One-year OS was 82.7%, 2-year survival 68.9%, and 3-year survival 55.2%. Conclusion MWA is a versatile ablative method that can be applied in HCC at various stages, and also in lesions located in risk areas. Keywords Microwave ablation . Hepatocellular carcinoma . CT scan . Percutaneous ablation Introduction Hepatocellular carcinoma (HCC) accounts for 5–6% of cancers diagnosed worldwide and represents one of the lead- ing causes of cancer-related death [1, 2]. Surgical resection and orthotopic liver transplantation offer the highest survival rates. However, less than 30% of patients with HCC are surgical candidates [2–5], as several conditions (e.g., locally advanced or metastatic disease, poor liver function, underly- ing comorbidities, and poor performance status) preclude sur- gical treatment. As a result, in the last decade, there has been a surge of ablative treatments for HCC, which have been shown to be effective in patients not suitable for surgery [6–9]. Among them, microwave ablation (MWA) can be consid- ered a relatively new method, which has showed promising results in ablation of liver tumors. One or more microwave antennas are inserted (generally with percutaneous technique) inside the tumor mass. The electromagnetic microwaves generate thermal energy that results in coagulative necrosis of the tumor and surrounding parenchyma [6, 10–13]. Literature reports that MWA has been increasingly used for treatment of hepatic malignancies, especially in Asian * Alessandro Fancellu afancel@uniss.it 1 Division of Interventional Radiology, Department of Oncological Radiology, Oncological Hospital A. Businco, Cagliari, Italy 2 New York University School of Medicine and Department of Surgery, NY Harbor Healthcare System VAMC, New York, NY, USA 3 Unit of Medical Oncology, Department of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy 4 Institute of Radiological Sciences, University of Sassari, Sassari, Italy 5 Unit of General Surgery 2-Clinica Chirurgica, Department of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy J Gastrointest Canc (2018) 49:295–301 DOI 10.1007/s12029-017-9951-8