This series of 99 consecutive hepatic resections for hepatocellular carcinoma (HCC) performed using microwave tissue coagulator (MTC) by one surgical team over a 10-year period shows results that compare with other reports in regard to blood loss, operation time, and clinical outcome. The mean blood loss was 838, 1948, 1765, 1325 and 6053 ml for partial (HR0), subsegmental (HrS), segmental (Hr1), lobar (Hr2), and lobar or extended lobar resection (ext. Hr2) with tumor thrombus in main portal trunk or having huge tumor 1kg or bigger. The mean operation time was 3h 43m, 4h 21m, 4h 36m, 4h 53m, and 7h 15m for Hr0, HrS, Hr1, Hr2, and ext Hr2. In Hr1 group, the blood loss and operation time were most minimized in patients who underwent lateral segmentectomy. In Hr2 group, mean blood loss and operation time were most higher in cenrtal bi-seg-mentectomy. The satety of the method described herein is evident by the in-hospital mortality rate of 3% and a morbidity rate of 13.1%. The 5-year survival rate was 41%. 5-year survival of 55 resection margin positive patients (49.6%) was not different with that of 23 resection margin negative patients (54%). Recurrence near the resected margin was seen in only 9 patients (12%). We concluded hepatectomy using MTC is useful, safe, reproducible, and applicable in liver surgery.
Background : Liver surgery using a microwave tissue coagulator (MTC) greatly diminishes the risk of hemorrhage during operation. But higher incidences of septic complications have also been reported. We investigated the operative efficacy and complications related to the use of MTC in hepatocellular carcinoma resection. Material and Methods : One hundred sixteen consecutive patients undergoing liver resection for hepatocellular carcinoma between 1976 and 1995 were included in this study (60 patients with MTC surgery, 56 without MTC). Postoperative clinical courses were evaluated retrospectively with special references to patients' characteristics and surgically-related complications. Results : Although patients with MTC surgery showed limited liver function with significant decreases in platelet counts (p = 0.004) and prothrombin time activity (p = 0.008) and significant increase in ICG15 (p = 0.048), incidences of postoperative bile leakage (5.4 % vs. 3.3 %), abscess formation (10.7 % vs. 6.7 %) and the average amount of blood loss were not different with or without MTC. Persistent fever lasting more than 1 week is encountered more in patients with MTC surgery, but with no statistical significance. No complications attributable to MTC were noted. Conclusions : These results led us to conclude that MTC can be utilized safely and effectively in liver resection for hepatocellular carcinoma, especially in patients with cirrhosis.
To establish a suitable technique that assureses us to bring more large coagulation area around the antena of needle electrode, is a great importance to succeed percutaneous microwave coagulation therapy for small liver cancer. Microwave coagulation under impaired liver blood circulation, that would be thought to influence on microwave coagulation range, was studied using a pig under general aneasthesia with treatment by Pringle method. Microwave coagulation range with treatment and without, was compaired. Maximal coagulation width with treatment versus without, was 29 mm vs 12 mm (3 minutes of microwave irradiation), 36 mm to 19 mm (5 min.), 35 mm vs 19 mm (10 min.) and 55 mm vs 25 mm (20 min.). In this result, the technique of microwave coagulation with interruption of liver blood circulation, may be applied to not only percutaneous microwave coagulation therapy but intraoperative or laparoscopic microwave coagulation therapy for liver cancer.
As a local treatment of hepatocellular carcinoma, percutaneous microwave coagulation therapy has been increasingly applied. This therapy, however, has some points to be improved and one of them is burn injury of the skin around the inserted electrode. In order to prevent burn injury, we have developed a new type electrode which has smaller temperature elevation on the surface of electrode nearly as half as compared with the former type of electrode without losing coagulation ability.
In a case of severely limited functional reserve of a liver cancer, apparently invading main trunk of a hepatic vein, we have performed microwave coagulation therapy (MCT) under laparotomy for the lesion of a tumor, containing surgical margin and the involved hepatic vein instead of major hepatic resection causing liver failure, as the experimental study of canine model concerning for microwave coagulation to a trunk of a hepatic vein revealed that the blood flow of a hepatic vein, completely necrotized by microwave coagulation, was preserved and the wall of the hepatic vein was regenerated with keeping enough venous flow of the hepatic vein.
Objectives : This study was undertaken to examine the morphological influence of microwave tissue coagulation on the intrahepatic main vessels (both the hepatic vein and the portal vein). We have tried to confirm the harmlessness of microwave tissue coagulation to the intrahepatic main vessels. Methods : The adult mongrel dogs underwent the liver coagulation near the intrahepatic main vessel using the microwave tissue coagulator. The liver tissue was punctured and irradiated by the 15 mm needle electrode with a microwave energy of 60 watts for 30 seconds and then the electrode was charged with a dissociating electric current for 20 seconds. Group A : The distance was 5 mm from the tip of electrode to the intrahepatic main vessel wall. Group B : The tip of electrode attached to the intrahepatic main vessel wall. Just and on the seventh day after the operation, we obtained the coagulated liver tissue and the vessel wall specimens through sacrifices and they were histologically examined (hematoxylin-eosin stain, elastica van Gieson stain, and using scanning electron microscope). Results : Group A : The coagulation of 5 mm diameter from the vessel wall have not injured them at all. Group B : The tunica adventitia was partially injured and the other layers (tunica media and tunica interna) were slightly degenerated, each layers were discriminated. The seventh day after the operation, the vessel wall which was not destroyed and the bleeding was not observed. Conclusions : Results of this study suggests that the microwave tissue coagulation may be useful and harmless, if it is used on the 5 mm far from the intrahepatic main vessel. The bleeding was not observed, even if the tip of the electrode attaches to the intrahepatic main vessel wall.
In patients with malignant tumors, it has been said that the antitumor cytotoxic abilities of lymphocytes are activated at an early stage but repressed at an advanced stage. In this study, patients were classified into four groups. The first group is preoperative patients, the second is patients in whom all tumor was removed curatively or has not recurred postoperatively, the third is patients who have inoperable multiple tumors and the fourth is patients in a terminal stage who are suffering from disseminated intravascular coagulation (DIC). T Cells and NK Cells in peripheral blood lymphocytes were investigated in them by FACScan. As a result, T Cells, CD3 + CD4 + Cells, CD3 + CD8 + Cells, CD3 + CD4 + Cells/CD3 + CD8 + Cells did not change significantly but NK Cells did so significantly. CD16 + Cells increased significantly and the ratio of CD56 + Cells/CD16 + Cells declined significantly at the advanced stage and the repression of CD56 receptors was recognized at the advanced stage. And so the ratio of CD56 + Cells/CD16 + Cells shows the anti-tumor immunological ability of a patient with a malignant tumor and the existence of CD56 receptor inhibitors is suggested at the stage. Patients in whom all tumor was removed curatively or no recurrence was recognized postoperatively had the highest ratio of CD56 + CD16 + Cells among the groups. This shows that such patients who are removed curatively and not recurrent have more active NK cells than other groups. In has been shown in vitro or in mouse that in parallel with the activation of NK cells, the expression of CD56 receptors increases, but not in patients with a malignant tumor. In this study, we demonstrate that the expression of lymphocyte CD56 receptors shows activities of NK cells and the ratio CD56 + Cells/CD16 + Cells relates closely to antitumor immunological ability in man. Regarding therapy, not repressing the CD56 receptors and not decreasing the ratio of CD56 + Cells/CD16 + Cells are important and increasing CD56 receptor may be one factor to decrease recurrence.
Since we began to perform Microwave Coagulation Therapy in inoperative patients suffering from a hepatocellular carcinoma with liver cirrhosis, we have experienced the reduction or the disappearance of the tumor. In this study we analyzed he subsets of T Cells and NK Cells of patients' peripheral blood by FACScan after Percutaneous Microwave Coagulation Therapy and investigated the anti-tumor immunological effects induced by the therapy. As a result, both NK Cells acquired high cytotoxic activity and increased transiently. The therapy also the ratio of CD3 + CD4 + Cells / CD3 + CD8 + Cells in patients suffering from hepatocellular carcinoma with liver cirrhosis transiently. Histological findings in the tumor are that fibrous tissues including collagen III and fibronection, many groups of CA19-9 staining and Epitherial Membrane Antigen (EMA) staining positive cells, a large number of histiocytes, fibroblasts and T Cells replaced hepatocellular carcinoma cells. Histological findings of hepatic tissue around the needle are that following in order from the puncture point, coagulation necrosis, apoptosis, fibrous tissue including many histiocytes and fibroblasts and few T Cells, atypical cells overlapped each other and replaced the original hepatic cells. In atypical cells, there were CA19-9 staining positive cells, EMA staining positive cells, vimentin staining positive fibroblasts and some of these atypical cells were denatured from hepatic cells to fibroblast-like cells by microwave. It is considered that in addition to the repair phenomenon of hepatic tissue, hepatic cells around the puncture area were transformed to CA19-9 staining positive cells and fibroblasts by the microwave and the same phenomenons in the tumor cells and fibroblasts by the microwave and the same phenomena in the tumor cells may occuured. It is mentioned that this phenomenon induced in the tumor by the microwave causes T Cells and histiocytes to infiltrate into tumor tissues and participate in the changes of peripheral blood lymphocytes directly or indirectly.
Recently microwave coagulation therapy (MCT) has been used clinically in the treatment of hepatocellular carcinoma (HCC). We have applied MCT for patients with nonresectable HCC because of poor hepatic function and advanced age. In this study we examined the changes of coagulated tumors with computed tomography (CT). After the first MCT trial in 1985, from April 1993 to December 1996, 21 patients, for whom radical surgery was impossible, received MCT under laparotomy or thoracoscopy. Two weeks after MCT, CT showed a low-density area around the tumors subjected to MCT. Gradually the tumors changed to an isodensity area. Fifteen of 21 patients are alive, with the longest survival being 32 months. In ten patients, HCC recurrence could not be detected at the time. Three patients died of another HCC during the course of observation. The coagulated tumor did not cause another recurrence around the tumor and it proved MCT is an adequate treatment. Also we compared MCT with partial hepatectomy. The patients had single tumor and poor liver function. The survival rate was similar and showed no difference. The operation time and bleeding were less than for partial hepatectomy. Intraoperative MCT appears to be an effective treatment for nonresective HCC patients from the standpoint of safety and accuracy.
We performed percutaneous microwave coagulation therapy (PMCT) on 89 patients (86 patients with hepatocellular carcinoma, 1 patient with liver metastasis from gastric cancer, 1 patient with liver metastasis from gastric schwannoma, 1 patient with both hepatocellular carcinoma and liver metastasis from colon cancer). CT was performed after PMCT to evaluated the efficacy in all cases. In 78 cases, complete necrosis of the lesions with some safety margin was achieved. In the other 11 cases, PMCT was used only palliatively, but the goal of mass reduction was accomplished. Encountered complications were pleural effusion, hemobilia, subcapsular hematoma, hemoperitoneum, biloma, and others. In conclusion, although PMCT is useful in the treatment of small or middle-size liver tumors, there are various problems to be solved. Improvement of the machine and others is mandatory.
We treated 9 patients with HCC by microwave coagulation under laparoscopy from April 1995 to December 1996. After observation of the surface of the liver during laparoscopy as usual, the lesions were punctured with the electrode needle, coagulated with 60 to 80 W for 45 seconds, and freed from the needle by passage of 20 mA for 15 seconds. In the 9 patients, 5 lesions were identified by the usual laparoscopic methods, but the 4 other lesions were not identified. These 4 lesions could be identified by laparoscopic ultrasonography and coagulated. Only one patient had severe pain during treatment, and dynamic CT showed that the lesion was not coagulated sufficiently, so percutaneous ethanol injection therapy was done. The lesions of the 8 other patients seemed to be coagulated sufficiently.
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.
Percutaneous ethanol injection therapy (PEIT) following percutaneous microwave coagulation therapy (PMCT) was performed in 6 patients with hepatocellular carcinoma (HCC) in whom neither surgery nor transcatheter arterial embolization was carried out. One patient has died due to rupture of hepatocellular carcinoma, and the survival period of all patients to date ranges from 10 months to 29 months (mean 26.2 month). Recurrence at the treated site was detected in two patients.
The possibleuse of percutaneous tranhepatic microwave tissue coagulation therapy (PMCT) by using ultrasonography under the local anesthesia for solotaru liver cancer was studied in this paper. Eight patients that was primary or metastatic liver cancer with solitary liver tumor less than 4 cm in size, consisting of 2 hepatocellular carcinoma, 6 metastatic carcinoma. PMCT was performed continuously 3 times at the out put of 30 watts for 30 seconds at a time. Tumor less than 3 cm in size was completely coagulated by enhanced CT. The coagulation area was not recognized recurrence of the tumor. But, in some cases, multiple metastases were recognized another site in the liver by 3 months after PMCT. Thus the results suggest that PMCT is the useful therapy for the small liver tumor as a local control.
Microwave coagulation therapy (MCT) was applied to 3 patients with synchronous metastatic liver tumors from colon cancer. After resection of colon cancer, MCT was administered to the liver lesions at 60-90W for 20-90 seconds per bout. We used the monopolar needle electrodes of various length, including an electrode which coagulates the tissue around only the tip. A total of 22 sessions was applied to the 3 tumors. Each patient received intrahepato-arterial chemotherapy after surgery. Abdominal computed tomography showed no blood flow in tumors undergoing MCT. Two of 3 patients are alive without recurrence 17 months highly effective for patients with metastatic liver tumors from colon cancer.
About 17 years passed since we started clinical application of the endoscopic microwave coagulation therapy (EMCT) in 1981. In this report, we give an outline of recent equipments and techniques of the endoscopic microwave coagulation therapy (EMCT) for early gastric cancer and investigate its position in terms of long term clinical results in our hospital.
We applied transurethral microwave coagulation therapy to urinary bladder diverticulum. The case is 71-year-old female who had two large diverticulums, 11 × 9 × 7 cm in size on the right lateral wall and 5 × 5 × 4 cm in size on the anterior wall. Electrode resection of diverticular neck was performed, and then all of the inside mucosa was coagulated with a microwave energy of 100 watts. This procedure was able to be performed safely to the end without any complications. After the operation, both diverticulums disappeared. It supposed that the transurethral microwave coagulation therapy was a useful procedure for the endoscopic treatment of urinary bladder diverticulum.
This report describes a new unroofing technique to secure an effective microwave coagulation therapy (MCT) for a case of hepatocellular carcinoma, which was deeply located in segment 5 adjacent to the confluence of right anterior and posterior portal pedicles. A 62 year-old man developed HCC in the context of liver cirrhosis caused by hepatitis C virus. Transcatheter arterial embolization was attempted initially because of the tumor location and poor hepatic functional reserve, but failed to achieve satisfactory remission. On laparotomy, hepatic parenchyma was superficially resected to uncover the ventral surface of deeply located HCC adjacent to major hepatic vessels, enabling an accurate as well as effective MCT. The patient has been alive and well without recurrence for five months following the surgery.
A 74-year-old man admitted for obstructive jaundice. After percutaneous transhepatic bilialy drainage, complete obstruction was detected at the hepatic hilus. Because of highly extension of the tumor we could not do the curative operation. So, intra biliality irradiation (8Gy, 4 times) was performed and Expandable Metallic Stent (EMS) was put into the intrahepatic to common bile duct. But five months later obstructive jaundice took place and PTCD was done once again. Microwave tissue coagulation therapy via percutaneous transhepatic cholangioscopy was performed bacause bile duct re-endoprosthesis was difficult in this time. Obstructive jaundice had not been occurred for seven months after microwave coagulation therapy. Endoprosthesis was performed by this treatment with safe. This treatment, farthermore anti-cancer effect was suggested, too.