Combined TACE and Microwave Ablation for Recurrent Spiegel-Lobe HCC: A Four-Case Series.

Background: The Spiegel lobe, a distinct subdivision of the hepatic caudate lobe, is characterized by its unique anatomical position, with close proximity to major hilar vasculature and extrahepatic structures. Therapeutic intervention for Spiegel lobe lesions remains technically challenging, with no established treatment protocol currently available. Case Presentation: This study reports four cases of recurrent hepatocellular carcinoma (HCC) in the Spiegel lobe treated with conventional transarterial chemoembolization (c-TACE) followed by microwave ablation (MWA) via a transhepatic left lobe approach. Postprocedural imaging assessment confirmed complete response (CR) in all patients according to mRECIST criteria. During a mean follow-up period of 33.75 months (range: 31-37), three patients maintained disease-free status, whereas one patient developed intrahepatic recurrence at 19.2 months. This patient achieved CR after repeat TACE-MWA combined with adjuvant lenvatinib and tislelizumab therapy. The mean overall survival (OS) was 33.75 months (95% CI: 31.2-36.3). Conclusion: The combination of transcatheter arterial chemoembolization (TACE) and microwave ablation (MWA) for treating recurrent hepatocellular carcinoma (HCC) in the Spiegel lobe was proven feasible in this series of studies, and demonstrated favorable efficacy and safety profiles.