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

Purpose 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 (CCDPP) within the coronal or sagittal plane under computed tomography (CT) guidance. Methods 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 cephalic within the coronal or sagittal planes reconstructed via multislicespiral CT. Baseline patient data were collected, and outcomes, including the puncture technique success rate, ablation success rate, and incidence of complications, were observed. Kaplan‒Meier survival curve analysis was used to calculate the disease-free survival (DFS) and overall survival (OS) rates of all patients. Results The puncture technique 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 22.7%, 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. Conclusion Microwave ablation with the CCDPP used in the puncture process is safe, feasible, and effective, with acceptable oncological midterm outcomes for the treatment of small HCC lesions in the hepatic dome.