The characteristic pattern of recurrence after microwave coagulation therapy for hepatocellular carcinoma: Local recurrence or peritoneal dissemination?

Abstract

We report the cases with local recurrence or peritoneal dissemination after microwave coagulation therapy (MCT) for hepatocellular carcinoma (HCC).
(Case 1) The patient was a 63-year old woman. Laparoscopic MCT (L-MCT) was performed for HCC. Local recurrence occurred 2 years after L-MCT, and considered to be caused by incomplete coagulation. When laparotomy was performed, peritoneal dissemination was found, and tumors were resected as many as possible.
(Case 2) The patient was a 74-year old woman. Open MCT (O-MCT) was performed for HCC. One year after O-MCT, recurrent tumor was found adjacent to the liver. We performed resection of this tumor. Ethiology of this tumor was considered also peritoneal dissemination.
Local recurrence due to incomplete coagulation is well-known as pattern of after MCT. During coagulation procedure, coagulated area becomes indistinct rapidly due to generation of micro bubbles. Accurate mapping of coagulation area guided by intraoperative ultrasonography before coagulation is the most important point before MCT. It is unknown if MCT typically causes peritoneal dissemination. In these cases with peritoneal dissemination. there was no extrahepatic metastasis apart from peritoneal dissemination, which is rare in HCCs. Thus, there is a possibility that peritoneal dissemination is characteristic pattern of recurrence after MCT.