Thoracoscopic microwave coagulo-necrotic therapy (thoraco. MCN) involves approaching lesions via the thoracic cavity and incising the diaphragm. It was performed in 13 patients with small hepatocellular carcinoma (s-HCC) located on the dome of the anterior superior segment or posterior superior segment of the liver, because surgical resection and percutaneous ethanol injection therapy were judged to be excessively cumbersome. In all 13 patients, oral feeding was possible on the first postoperative day and no complications were observed. Twelve patients survived up to one year and seven months postoperatively, except for one patient who died seven months after surgery. On CT scan two weeks postoperatively, the treated region including the cancer showed a marked change to a low density area and no enhancement. Thoraco. MCN was concluded to be a useful new method of endoscopic surgical treatment for s-HCC located on the dome of the liver, both therapeutic efficacy and minimal invasiveness.
In order to extend the possible use of the microwave tissue coagulation (MTC) in the liver tumor, macroscopic and histological changes in thigh muscle of the pig after microwave irradiation using a new type needle electrode of that size was 21 gauge was examined in this study. The needle-electrode of MTC was introduced into the center of the muscle under the guide of the ultra sonography and MTC was performed at the out put of 20 watts for 30 seconds at a time, The maximum coagulation area of the MTC in the fresh cut surface of the muscle was 20mm×10mm in size when it was irradiated continuously ten times, and was oval shaped. The coagulation area was changed necrosis strongly stained with hematoxylin. Internal echo pattern of the coagulation area of the MTC was changed heterogeneously surrounded with low echoic region. Thus, the result suggests that this new type needle-electrode is effective in the small liver tumor at the bed side treatment.
The synchronous use of microwave irradiation (50-60 Watt) and dissociating electric current (20mA) was newly applied to the percutaneous microwave coagulation therapy. The color evaluation in the albumen of eggs revealed that the rnicrobubbles generated by synchronous dissociating electric current prevented the coagulated albumen from gluing on the needle-electrode. The fine needle-electrode which was 250mm in length and 1.6mm in diameter produced by Heiwa Electronic Co. Ltd. was used for the microwave coagulation of the tumors through the Tru-Cut biopsy needle under ultrasound guidance. This method was newly applied to 2 clinical cases. The case 1 was the 74 female, metastatic liver cancer patient, who had the history of colectomy and left lobectomy of the liver. The target was the solitary 2.5cm sized lesion located in the Couinaud's segment 6. The enhanced CT scan after the microwave coagulation therapy revealed that the lesion became 3 cm sized low density area which implied the lesion was successfully coagulated. The case 2 was the 63 male, recurrent hepatocellular carcinoma patient, who had the history of partial resection of the liver and transcatheter arterial embolization. The targets were multiple but they were less than 2cm in diameter. After the treatment, the tumor stains were disappeared on the dynamic CT scan. The outcome of these cases were 14 months and 12 months survival after the treatment, respectively. It is demonstrated that the liver tumor less than 3cm in diameter may become therapeutic indication of the percutaneous microwave coagulation therapy by the synchronous use of microwave irradiation and dissociating electric current.
99 patients were operated on between January 1988 and September 1991 for Microwave coagulo-necrotic therapy (AWN). Before, we were reported as complication of MCN that occured very few. But sometime we have experience of severe complication after MCN, Recently 7 patients (7, 1%) have abscess formation after MCN, These abscess should atendency to increase, maximam tumor size were more large size. And we have only 2 patients that positive result of bacteria examination of abcess. We considerated these abscess depended quantity of necrotic tissue due to MCN. Almost every patient have got well within 1 month by drainage of abscess. At that time, 95% ethanol was very useful for reduse of size of abscess.
We investigated the effects of the treatment on the deep coagulation therapy in combination with hepatectomy of 7 cases of hepatocellular carcinoma with the intrahepatic metastasis. Therapeutic effect was able to be evaluated with dynamic CT on the 4th week in all the patient. Postoperative courses of 7 patients were uneventful, including recurrence-free periods of more than 12 months of 4 patients. These findings indicate that this coagulation procedure is a useful therapy for the deep cancer lesions of the hepatoma with multiple metastasis.
We have succesfully been performed new surgical treatment for five patients with the hepatocellular carcinoma (HCC) which we called mini open microwave coagulo -necrotic therapy, because these patients was judged impossible to attempt endoscopic procedure on account of remarkable adhesion. There was no postoperative complication. The gastric tube was extubated on the first or second postoperative day, and the patient was able to eat. The treated area was seen as markedly low density area including HCC and was not enhanced on CT image two weeks after MCN. Therefore this method have led us to significant treatment with therapeutic effect and the quality of life in no way inferior to endoscopic MCN.
The therapeutic significance of microwave tumor coagulation (MTC) in unresectable liver tumor was investigated. Since April 1990, we have performed MTC on 25 patients withliver tumor (4 with hepatocellular carcinoma, 21 with metastatic liver tumor: 11 from colorectal cancer, 3 from breast cancer, 2 from gastric cancer, 2 from pancreatic cancer, 2 from small intestinal or gastric leiomyosarcoma and 1 from gallbladder cancer). Concomitant therapies were ethanol injection in 2 subjects, hepatectomy in 11 and selective arterial infusion chemotherapy in 19. Following electrode penetration into the hepatic lesion under echo guidance, the lesion and surrounding area were thermally coagulated at 100 W until high echoes were obtained thereform. Although transient liver dysfunction was noted in all patients, all had remission, and were discharged from the hospital without significant complications. To determine indications for, and limitations of. MTC, survival periods were compared by underlying disease, number of tumor masses coagulated, and maximum tumor size, in 20 subjects who had undergone MTC at least 1 year previously. Of the 20, 11 survived for I year or longer, including the 2 with hepatocellular carcinoma, the 2 with breast cancer and the 2 with leiomyosarcoma, and 4 of the 9 with colorectal cancer and 1 of the 2 with pancreatic cancer. All with gastric or gallbladder cancer died within I year. All patients who survived for I year or longer had at most 10 tumor masses (of up to 3 cm diameter) coagulated.
Intraoperative microwave tissue coagulation (MTC) therapy was applied 8 patients with multiple hepatocellular carcinoma (HCC) with liver cirrhosis in which radical surgery was impossible. A total of 222 MTC sessions was applied to 21 tumors. MTC was administered for 20 seconds in each session. Microwave energy output was 70 watts for 15-mm needle-electrodes. Alpha-fetoprotein levels in serum had decreased in all cases one month after surgery. Abdominal computed tomography showed no blood flow whatsoever in tumors undergoing MTC. Needle biopsy after MTC confirmed complete necrosis. All patients are alive, the longest one having survived 24 months. We conclude that intraoperative MTC is highly effective in tumor necrosis, and can be an useful local treatment for multiple HCC.
The microwave coagulo-necrotic therapy with perctaneousmicrowave needle for deep lesion were performed in 7 tumor lesions of 4 patients. They were 2 hepatoceller carcinomas and 2 metastatic liver carcinomas. Each 7 lesions existed in inside from liver surface. At laparotomy, monopolar electrodes were inserted with an ultrasonic guide. One round of coagulation lasted for 30 seconds at 60w. Except for one patient (Esophageal cancer with liver metastasis), 3 patients are alive for 12-16 months. Almost of complications were not observed after this therapy. This method acts directly on tumors and is simple and safe. In this time, microwave coagulation for liver tumor were underwent, because of hepatic dysfunction, multiple liver tumor or absolute unresection of primary lesion. Therefore, it seems to expect as a useful means for regional treatment of tumors. But, through the repeated experience of various cases, we must decide the indication of this therapy.
Microwave coagulation therapy was applied to hepatocellurar carcinoma or metastatic liver tumor by percutaneous route. Our microwave apparatus have an ability of coagulation for the liver tumor up to 35mm in diameter. Thus, in the treatment for the HCC or metastatic liver tumor, the size is within 35mm, this method is easy for practice, the most effective and less risky procedur.
Experimental studies were carried out in order to investigate both the efficacy of microwave coagulation therapy and the feasibility of percutaneous microwave coagulation procedures on a rabbit implanted VX-2 renal tumor. In the first experiment, a VX-2 tumor mass (1 cubic mm) was inoculated into the left kidney of 18 rabbits. The rabbits were divided into 3 groups according to the type of subsequent treatment; these include nephrectomy, microwave coagulation, and “no treatment” groups. The survival rate in the microwave coagulation group was significantly higher than that of the “no treatment” group, but was the same as that of the nephrectomy group. Serum creatinine and BUN levels did not increase after microwave coagulation, although both increased significantly until 4 weeks following nephrectomy. In the histological evaluation, carcinoma cells completely disappeared following microwave therapy. In the second experiment, percutaneous microwave coagulation on the implanted renal tumor was performed under ultrasonographic and laparoscopic monitoring. These 2 monitoring systems made it possible for us to perform a safe and complete coagulation procedure. Our results indicate that microwave coagulation may be a curative method of treatment for small renal tumors, and that either ultrasonographic monitoring or laparoscopic monitoring facilitates percutaneous microwave therapy of renal cancer in a clinical situation.
Between April 1985 and June 1993, 124 consecutive patients with urinary bladder carcinoma underwent transurethral microwave regional coagulation therapy (MRC). Of these patients, 108 had neither lymphnode metastasis nor distant metastases. We investigated the survival rate and the prognostic significance in the 108 patients. We also performed intracavitary irradiation in patients who had been suffered frequent recurrences. The prognosis of 79 patients with superficial tumor (Ta, Ti, NOMO) and that of 29 patients with muscle infiltrating tumor (T2, T3, NOMO) resulted in the survival rate of 80.7% and 69.0% after 5 years, respectively. The death rate of patients with high grade tumor (G3) was significantly higher than those with G1 and G2 tumors. With MRC the preservation rate of the urinary bladder was 66% in the patients with muscle-infiltrating tumors. In conclusions, these results indicate that we might be able to treat the invasive urinary bladder cancer by MRC without lymphnodes nor distant metastases as well as superficial cancer.
Previously I reported three microwave coagulators for ENT diseases. Thereafter, accumulating cases, I made two more new coagulators, one is a curved double needle electrode, and the other is a bifoliate formed electrode. Using these coagulators, I conduct hemostasis of bleeding points, destruction or reduction of pathologic tissues, and try to prevent infection for promotion of healing.
We report a 54 years old patient with an unresectable large hepatocellular carcinoma (6.5cm in diameter), who underwent microwave coagulo - necrotic therapy (MCNT) under laparotomy. Microwave radiation time was totally 15 minutes. This patient is still alive without local recurrence in 24 months after MCNT. MCNT can be a option of treatment for HCC of nodular growth, when resection is estimated to be risky because of coexisting severe liver cirrhosis.
We reported a case to perform laparoscopic fenestration of a large symptomatic liver cyst using two newly deviced microwave scalpels (blade type and round type electrode). A 51-year-old female was admitted to our hospital with a chief complaint of upper abdominal fullness on April 4, 1993. Ultrasound examination and computed tomography of the abdomen revealed a large liver cyst of the left lateral segment and its protrusion fromliver surface. We decided to resect the dome of the liver cyst by laparoscopic means. The liver cyst was punctured and the contents, brown fluid evacuated. After incision of the collapsed cyst wall the cyst membrane was widely excised with blade type microwave electrode. And the internal surface of the cyst was coagulated with round type microwave electrode. The patient recovered well and discharged home on the 7th postoperative day. Three months later, she was still asymptmatic and showed small low density area of the lateral segment of the liver by abdominal CT examination. Laparoscopic fenestration of the liver cyst and coagulation of its internal surface using microwave coagurator was a new useful surgical procedure.
In recent years. We have various treatment options for hepatocellular carcinoma (HCC), including hepatic resection, transcatheter hepatic artery embolization (TAE), and percutaneous ethanol injection (PEI). However, some cases of HCCs are not suitable for these therapies due to their liver function and location of tumors. For some of these HCCs, we have developed laparoscopic microwave coagulonecrotic therapy (L-MCNT). The case of this report was 57-year-old man. The tumor was located in segment 8. The duration of MCNT was 30 minutes. The period of hospitalization after MCNT was 14days. Coagulated area involving tumor and surrounding tissue was not enhanced by postoperative dynamic CAT scan. L-MCNT is useful therapy for some HCCs.