血管医学および外科ジャーナル

概要

Microwave Coagulation Therapy Combined with Laparoscopic Liver Resection for Hepatocellular Carcinoma in Cirrhotic Patients

Hong-wei Zhang, Ya-jin Chen, Xuan Luo and Jun Cao

Objective: Image-guided microwave coagulation therapy as a minimally invasive technique has been widely used for the treatment of small HCC in patients who have high surgical risks. However, tumor residual after thermal albation is still the main reason of HCC recurrence. Laparoscopic resection of the tumor after thermal ablation will take advantage of reducing the risk of tumor residual without increasing the risk of hepatic failure. The aim of this study was to evaluate the feasibility and safety of this technique. Methods: From 2008 to 2010, 18 patients (15 men and 3 women; age range, 35-77 years) with HCC and associated severe liver cirrhosis underwent microwave coagulation therapy combined with laparoscopic liver resection. Inclusion criteria were solitary, peripheral or subcapsular HCC lesions localised to the left or anterior right segments; lesion size less than 4 cm; Child-Pugh grading class B or class C. Mortality, morbidity and recurrence rates were analyzed. Results: A total of 18 patients were included. There was no conversion to open operation. The mean operation time was 105 min (range, 70~155 min) and the mean blood loss during operation was 95 ml (range, 40~160 ml). No patient needed blood transfusion. The complications after operation included: pneumonia in 1 patient and mild transient jaundice in 2 patients (<45 μmol/L). None developed ascites, coagulopathy, or encephalopathy. There were no postoperative bile leaks, hepatic failure, and death. The mean hospital stay was 9.5 d (7~16 d). Complete tumor necrosis was found in 14 patients, while tumor cells were found in the resected specimen of the 4 other patients by pathological examination. The mean resection margin was 8.3 mm (range, 6~11 mm). After a mean follow-up of 13 months (range, 5~28 months), 2 patients (2/18) developed tumor recurrence in the liver. Conclusion: Our study shows that microwave coagulation therapy combined with laparoscopic liver resection for hepatocellular carcinoma in cirrhotic patients is feasible and safe.