Although cancer resection has been of great benefit to patients with colorectal cancer, an unrecognized flaw that has caused the death of countless patients das not been confronted. Aithough the surgeon has dealt successfully with the primary tumor, he has neglected to treat microscopic residual disease. Cancer cells left behind within the abdomen and pelvis are responsible for the death of 30-50% of the patients who succumb to this disease and is responsible for devasting quality of life consequences that result from intestinal obstruction caused by cancer progression at the resection site and on peritoneal surfaces. Optimized surgical techniques for colorectal cancer removal minimize the microscopic residual disease that may result from surgical trauma. New developments in exposure, hemostasis, adequate lymphadenectomy and qualitatively superior margins of excisions have reduced the incidence of cancer persistence. Clinical data shows that a 40% improvement in survival with an optimization of resection techniques is possible. Not only should the surgical event for primary colorectal cancer be optimized, but also knowledgeable management of peritoneal carcinomatosis should be pursued. Resection site recurrence and peritoneal seeding can be prevented through the use of perioperative intraperitoneal chemotherapy in patients at high risk of persistent microscopic residual disease. These are patients with a performed bowel wall by cancer, positive peritoneal cytology, ovarian involvement, tumor spill during surgery and adjacent organ involnement. Patients with established peritoneal carcinomatosis can be salvaged with an approximate 50% long-term survival with knowledgeable and timely use of peritonectomy procedures, intraperitoneal chemotherapy and patient selection factors. Peritonectomy procedures employing lasermode electrosurgery allow the removal of all visible peritoneal surface cancer with an acceptable surgical morbidity (25%) and mortality (1.5%). Heated intraoperative intraperitoneal chemotherapy using mitomycin C, in addition to early postoperative intraperitoneal 5-fluorouracil, will eradicate exposed microscopic cancer seeding in a majority of patients. The Peritoneal Cancer Index which quantitates colorectal cancer carcinomatosis by distribution and by implant size must be used in the selection of patients whomay benefit from these advanced surgical oncologic treatment strategies. The goal must be complete cytoreduction for the Completeness of Cytoreduction Score is the most powerful prognostic indicator in this group of patients. The data clearly shows that there are no long-term benefits unless a complete cytoreduction combined with intraperitoneal chemotherapy occurs. Coclusions are as follows : Proper techniques for the resection of primary disease, peritonectomy procedures for the removal of all visible peritoneal implants, intraoperative and early postoperative chemotherapy for the eradication of microscopic residual disease, and quantitative tools for proper patient selection are necessary for the surgical treatment of patients with colorectal cancer.
The authors report the progress of surgery in 3227 patients with pathologically proven primary liver cancer (PLC) over the past four decades (Jan. 1958-Dec. 1997), and the factors improving long-term outcome. The 5-, and 10-year survival after resection of PLC was 44.3% and 33.2%, respectively, for the whole series (n = 2276), and 65.5% and 47.6%, respectively, for patients with small PLC (< = 5cm, n = 861). The 5-year survival after cryosurgery was 39.8% for the whole serias (n = 235), and 55.4% for patients with small PLC (n = 80). The 5-year survival of 93 patients receiving sequential resection after cytoreduction therapy was 64.5%, The 5-year survival after re-resection for recurrence tumor (n = 202) was 35.4% ; 328 patients survived more than 5 years ; 187 of these patients (57.0%) were small PLC, and 109 patients survived more than 10 years. Microwave surgery was used for resectable and unresectable PLC. Encouraging changes in the prognostic pattern were observed when the PLC data 1958-1967 (n = 118), 1968-1977 (n = 356), 1978-1987 (n = 715) and 1988-1997 (n = 2038) were compared ; the 5-year survival being 2.8%, 7.3%, 27.1% and 52.5% respectively, and the 10-year survival being 2.8%, 4.3%, 19.8% and 39.9% respectively. It is concluded that early detection and resection of small PLC is the leading approach to get long-term survivors, cytoreduction and sequential resection might be an important approach to improve the prognosis of patients with unresectable PLC, re-resection for subclinical recurrence and metastasis after an initial curative resection was also important to prolong survival further. Microwave surgery and cytosurgery as minimally invasive therapy have certain advantages in the treatment of PLC.
Multifocal carcinogenesis is caused by persistent infection by hepatitis viruses, and is considered the main cause postoperative recurrence of hepatocellular carcinoma. It has generally been believed that no single therapeutic modality (including resection) can improve the survival rate. In this paper, we describe the efficacy of microwave coagulation therapy and its indications for treatment of HCC based on an analysis of cases experienced at our institution over a 10-year period. We compare background factors, recurrence rates, and survival rates for various therapies, and conclude that microwave coagulation therapy is highly effective for tumor coagulation and necrosis. Microwave coagulation therapy is also technically easier than surgery, has fewer complications, and features survival rate equol to those of hepatectomy and local ethanol injection therapy. Due to these intrinsic advantages, microwave therapy is useful not only for treating recurrence, but also as primary therapy for small liver tumors. When the rate of detection of small liver tumors increases, microwave coagulation therapy will begin to play an even more important role in the treatment of hepatocellular carcinomas as a less invasive option, in addition to laparotomy and percutaneous/laparoscopic surgery.
To clarify the indication of percutaneous microwave coagulation therapy (PMCT) for hepatocellular carcinoma (HCC) as day surgery, we analyzed 43 patients who underwent PMCT. These patients were divided into two groups : 14 patients who were performed PMCT in outpatients and 29 were in inpatients. We compared the clinicopathological features between the two groups retrospectively. The liver function of outpatient group was better than of inpatient group. No patient that liver function had become worse after PMCT was seen even in inpatient group. For all outpatient group patients, PMCT could be done safely without severe complication. In effectiveness, there was no difference between two groups, but for large HCCs that were 2 cm or larger in diameter, it was worse in both groups. Indeed day surgery PMCT was performed for selected patients with better liver function, but it could be done safely and the effectiveness compared similarly with inpatient group. So, day surgery PMCT should be selected as one of the treatment for HCC.
In three of 20 patients with liver tumors who underwent baloon-ischemic percutaneous microwave coagulation therapy, computed tomography during arterial portography (CTAP) images with balloon occlusion of the hepatic vein revealed localization of a tumor on the borderline of the middle hepatic vein region and the right hepatic vein region. Patient 1 : had metastatic liver cancer in S5, measuring 20 mm in diameter. Microwave coagulation was performed at 60W for 10 minutes under balloon occlusion of the right hepatic artery and hepatic vein. A coagulation area which measured 40 × 24 mm resembled a CTAP image under right hepatic vein occlusion. Patient 2 : had metastatic liver cancer in S5, measuring 15 mm in diameter. Microwave coagulation was performed at 60W for 5 minutes under balloon occlusion of the middle hepatic vein and proper hepatic artery. A coagulation area which measured 50 × 27 mm protruded hemispherically into the middle hepatic vein region. There was little coagulation of the right hepatic vein region. Patient 3 : had hepatocellular carcinoma in S5, measuring 29 mm in diameter. Microwave coagulation was performed at 60W for 8 minutes under balloon occlusion of the right hepatic vein and embolism with gelatin sponge A5 and A8. A coagulation area which measured 48 × 31 mm expanded to the ischemic, right hepatic vein region. In balloon-ischemic microwave coagulation on a segmental borderline, a microwave coagulation area extends matching to the portal venous blood flow occlusion area with a hepatic vein balloon. The microwave coagulation area expanded clearly on the hepatic vein occlusion side, whereas on the hepatic vein non-occlusion side, the microwave coagulation area was obviously limited.
In 177 patients with hepatic tumor (245 nodules) undergoing percutaneous microwave coagulation therapy (PMCT), tumor persistence and local recurrence were compared with regard to tumor size and the method of treatment in order to identify suitable candidates for PMCT. Tumors measuring less than 20 mm in diameter showed a good response to PMCT. And the therapy was more effective under general anesthesia than under local anesthesia. PMCT is best indicated for tumors less than 20 mm in diameter. And under general anesthesia, effective local treatment are possible. Therefore, it seems important to achieve reliable and complete coagulation at the initial treatment session.
We divised several therapeutic tools ti extend indications of microwave coagulation therapy (MCT) for hepatocellular carcinoma (HCC). Percutaneous MCT under artificial hydrothorax or ascites was performd in the surface of the liver, respectively. Isoechoic hepatic tumors can be enhanced by intraarterial infusion of carbon dioxide microbubble in albumin solution, detecting as a high echoic tumor by ultrasound (CO2 angio-US). It is extremely difficult to follow accurately the extent of MCT injury in real-time by US during procedure. However, the coagulation area over 4 cm in diameter can be achieved by multi-needle insertion technique. Thus, we indicate percutaneous MCT for HCC under 3 cm in diameter. In patients with large hepatic tumors, transcatheter arterial chemoembolization reduced the tumor size and able to indicate for HCC by which complete tumor necrosis can be obtained. HCC located adjacent to the Glisson capsule of the liver was treated by MCT under biliary cooling to prevent bile duct injury. In conclusion, our new devuces make to extend the indication of MCT for HCC. Thus, MCT may be a safe and more applicable therapeutic modalities for HCC.
The purpose of present study was to clarify the indication and limitation of Microwave Coagulation Therapy (MCT) under laparotomy for the tumors, which anatomical location were classified by the trunk of hepatic vein (THV) and the proximal glisson (PG). Method : Twenty eight patients with hepatocellular carcinoma (HCC), who had not been able to receive hepatectomy because of their poor liver function, underwent laparotomic MCT. They were classified into three groups ; peripheral type (P group, 10 cases) : tumors located remote from THV and PC ; THV invading type (G group ; 9 cases) : tumors invaded or compressed THV ; PG invading type (G group : 9 cases) : tumors invaded or compressed PG. Results : No complication was not recognized in P group and one (11.1%) in V group, whereas three complications (33.3%) were noted in G group. No local recurrences (22.2%) in G group. Conclusions : MCT in the P and G groups seems to be indicated, however MCT should be carried out carefully in the G group because of the high morbidity rate of complications and recurrences related to bile duct.
Background : Usefulness of endoscopic microwave coagulation therapy (E-MCT) was examined in 27 patients with hepatocellular carcinoma (HCC). Material and Methods : HCC was found in 8 patients with type B liver cirrhosis (LC), 16 patients with type C LC, and 3 patients with non B non C LC. Median tumor size was 23 mm (solitary lesion 22, multiple 5). Laparoscopic MCT was performed for S2-6 lesion and thoracoscopic MCT for S8 lesion under general anesthesia. Linear type ultrasonography was used in every case for monitoring lesion ant therapeutic effect. Results : Complete tumor necrosis was obtained in 24 cases (81%) and local recurrence was found in 5 cases after the observation period of maximum 34 months. Pleural abscess, hemorrhage and hepatic infarction were found in 3 cases without serious outcome. Conclusions : We conclude that E-MCT is quite promising therapy for surface type HCC in term of minimally invasive and curative procedure a time. It is important that sufficient marginal coagulation should be obtained.
Percutaneous microwave coagulation therapy (PMCT) was performed in 12 patients with hepatocellular carcinoma (14 nodules) on the liver surface. No serious complication included the peritoneal bleeding was detected after PMCT. Artificial ascites between the abdominal wall and the tumor on the liver surface prevented the burn of the abdominal wall by the microwave irradiation and severe pain was not complained in any cases. Local recurrences were not observed in 10 nodules less than 3 cm in size. Thus, these results suggest that PMCT is a useful therapy for small hepatocellular carcinoma on the liver surface.
We treated 30 patients with hepatocellular carcinoma (HCC) by laparoscopic microwave coagulation therapy (LMCT) and 5 patients with hepatic tumors by laparoscopic hepatectomy (LH). LMCT : The HCC was between 10 and 35 mm in longest diameter. After observation of the surface of the liver during laparoscopy as usual, the lesions were punctured with a electrode needle, coagulated with 60 to 80 W for 45 seconds. The efficacy of LMCT was evaluated by dynamic CT or dynamic MRI. After LMCT, 3 lesions of 3 patients were thought to be coagulated insufficiently and additional therapy was needed. The lesions of the other patients seemed to be coagulated sufficiently. LH : We treated 5 patients by LH under general anesthesia. The longest diameters of tumors were between 13 mm and 45 mm. All tumors were located at the edge of the liver. We coagulated the surrounding tissues around the tumors with the above mentioned method and resected the coagulated lesions with Laparoscopic Coagulating Shears System. The bleeding were few and no serious complications were not found. Conclusions : Laparoscopic treatment for HCC was useful but the indication was restricted by location of HCC.
Of 55 nodules in 49 cases performed PMCT from May of 1994 to September of 1998, 29 nodules in 24 cases that had undergone monotherapy with PMCT over one year were used for examination of indications and limitations of PMCT based on local recurrence. The study suggests that efficacious indications for PMCT be cases in which tumor nodule diameter is 2 cm or less with well differentiation, resulting in virtually no local reoccurrence. For radical PMCT, electrode puncture and coagulation must be conducted in accordance with tumor diameter while the required times of puncture is considered to be an integral number rounded up from the maximum section area (cm2) of tumor. It should be noted that further study in required in cases with a greater tumor nodule diameter and lower differentiation.
We investigated the advantage to hepatectomy with combination of microwave tissue coagulator (MTC) and hepatic vascular occulusion. Fourty one consecutive patients undergoing hepatic resection by our method were evaluated with references to comparison of reported hepatectomized cases using MTC without hepatic vascular clamp. We performed microwave coagulation only along the intended liver surface resection line and no more, then urtrasonically guided liver resection initiated along with coagulated line by forceps frature method with intermittent vasucular occulusion. The efficacy of MTC in hepatectomy, as many authors reported, was reduction in blood loss during operation without vasucular clamp i.e. warm ischemia of the liver which regarded as contraindicates to dameged liver. This 41 consecutive liver resections consisted of partial (Hr0 : 13), subsegmental (Hr1 : 13), segmental (Hr1 : 8), lobar (Hr2 : 1), extended lobar (Hr2 + : 1). In this study, the cases of postoprerative intrperitoneal infection, bile lekage, hemorrhage, was one respectively (2.4%) and ascites were 2 cases (4.9%), pleural effusion were 3 cases (7.3%). The average amount of blood loss was 763 ± 110 ml and average volume of resected liver was 194 ± 209g. The post operative laboratory data related to liver function changed within accepatable range reasonable for operative magnitude. Intraperative blood loss, postoperative complications' rates, postoperarive clinical courses were all not only diferent with using MTC without hepatic clamp but also more favorable results. No complications attributable to combined usage of MTC and vascular clamp were emerged. We concluded that combination of MTC and hepatic vascular occlusion was very useful for safer hepatic resection.
Successful resection of vascular-rich tumors in based on controlling to bleed during operation. Therefore, hemorrhage and hemostasis has consistently been a challenge to meningioma surgery. Six cases of large-sized meningiomas were treated with microwave coagulator. Putting the heat effects of microwave into practical application results in superior coagulation and hemostasis. All tumors were totally removed with minimal blood loss. For surgical removal of large bloody tumors such as meningiomas, the microwave operative instrument is a safe and useful surgical tool.
We reported a laparoscopic technique for cholecystectomy using a microwave scalpel devise (blade type electrode) developed in 1991. This devise was applied in laparoscopic cholecystectomy, without using electrocautery or lasers, and good results were obtained. The patients were divided into 3 groups : early period (February 1991-March 1993 n = 70), middle period (April 1993-March 1996 n = 88) and late period (April 1996-March 1998 n = 11), The study focused on the historical transition in surgical techniques. In this paper, it is demonstrated that microwave laparoscopic cholecystectomy is a technically easy and useful surgical procedure, compared with conventional safety elecrocautery, and that it is possible to perform the operation safety with excellent hemostatic results.
We access a usefulness of nephron-sparing surgery with a microwave tissue coagulator (MTC) for renal cell carcinoma (RCC). Selected 11 patients with small RCC who underwent partial nephrectomy using MTC during January 1998 to September 1998 were evaluated ; They were 9 men and 2 women aged 33-73 years. Three patients were indicated as single kidney and 8 were elected indication. Tumors were 1.4-4.0 cm in size, 6 located in the lateral position, 3 in the proximal position, 2 in the renal hilum. All patients were performed partial nephrectomy without clamping renal vessels and preserved renal function without serious complications. There were no significant differences in the operation time and the blood loss between this procedure and the conventional partial nephrectomy. Our results demonstrated that non-ischemic nephron-sparing surgery using MTC was a useful procedure and would apply to laparoscopic surgery.
A 65-year-old man was diagnosed as having hepatocellular carcinoma (HCC) with liver cirrohosis classified clinical stage, which caused by hepatitis C virus. Abdominal contrast CT showed HCC in the diameter of 2 cm located Segment 4. Laparoscopic microwave coagulation therapy under hepatic blood flow occlusion using clamp was performed. We applied the coagulation time for 10 minutes with an output of 80 watts for 60 seconds at a time. After 2 months the hepatic tumor was completely enclosed within the coagulation area and no recurrence was showed for 14 months after procedure. We have reported that the coagulation areas with the hepatic blood flow occlusion was about twice as big as that without blocking the hepatic blood flow. This suggested that a 3 cm hepatic tumor can be controled by this method. We proposed that laparoscopic microwave coagulation therapy under hepatic blood flow occlusion should be selected for HCC of small size or middle-size hepatic tumor and high risk patients.
The purpose of this study was to apply the microwave coagulation method to uterine leiomyoma as a possible conservative therapy. Uterine leiomyoma nodes were coagulated with a microwave coagulating apparatus after excision or in situ at the beginning of myomectomys, and the state of degeneration was examined by light microscopy. In one case, the nucleus of uterine leiomyoma was coagulated by microwaves at laparotomy and the clinical course was observed without myomectomy. Degeneration of leiomyoma tissue in a range of 7 mm from the coagulating needle was observed in extracted tissues and in tissues of in situ coagulation. In the case of in situ coagulation without myomectomy, the nucleus of uterine leiomyoma was reduced by 70% in cross section area after 18 months. The microwave tissue coagulation method is recommended as a conservative therapy for uterine leiomyoma.
Thoracoscopic microwave coagulonecrotic therapy (TMCT) has been reported to be one of the useful approaches in the management of hepatocellular carcinoma (HCC) that is located in the subphrenic area of the liver. In the present study, TMCT was performed on a 75-year-old woman with HCCs and liver cirrhosis. On admission, computed tomography revealed low density areas [exceeding 3 cm in Couinaud's segment 8 (S8) and 1 cm in segment 2 (S2)]. TMCT was selected for the HCC in S8 because percutaneous ethanol injection therapy (PEIT) and transcatheter arterial embolization (TAE) were not effective and surgical resection was not possible due to hepatic dysfunction and multicentric carcinogenesis. A thoracoscope was introduced into the thoracic cavity through the 5 th intercostal space on the midaxillary line, and two other trocars were placed in the appropriate intercostal spaces along the anterior and posterior axillary lines. We treated the HCC in S8 with TMCT across the diaphragma using laparoscopic ultrasonography and in S2 with intraoperative PEIT to avoid complications due to its location near Glisson's sheath. The efficiency of the coagulation and ethanol injection was proven by employing postoperative enhanced computed tomography. It was suggested that multimodal minimally invasive treatment such as TMCT is effective when combined with interstinal therapy for multiple HCCs with liver cirrhosis.
We treated 20 patients with hepatocellular carcinoma or metastatic liver cancer by microwave coagulation. Microwave tissue coagulation therapy (MCT) was performed via percutaneous route (PMCT) or laparoscopic guidance (LMCT). These approaches were chosen according to tumor location and the degree of hepatic reserve. MCT was completed in all patients in present series without complications. Tumor necrosis, including the surrounding liver tissue, was confirmed by a dynamic CT scan taken one month to three months after MCT, showing no enhancement of the low-density area. LMCT or PMCT can be a promising therapeutic modality as a new option of local treatment because of negligible intraoperative blood loss, no significant postoperative complication and rapid return of patients to their preopertive activities.
The purpose of percutaneous transhepatic low output microwave tissue coagulation therapy (PLMCT) is to locally treat using ultra-sonography under local anesthesia for small liver cancer. Usefulness of PLMCT has been described. This paper introduces special techniques which are useful to make the best use of PLMCT for liver cancer. Precautions necessary in procedure for PLMCT are as follows : 1) First of all, 16G needle aspiration biopsy of the liver tumor must be percutaneously performed under ultrasonographic guidance, and then 18G needle electrode is inserted into the 16G needle as a introducer. When this procedure is carried out, the needle electrode must not be pushed over the end of the introducer, for 18G needle electrode is weak. 2) While coagulating the tumor, the introducer had better be spun. 3) If the needle electrode is hot, cold alcohol had better be sprinkled on the needle electrode. We conclude that PLMCT is less invasive practical procedure for small liver cancer as a local control.
Microwave coagulation therapy (MCT) induces tumor coagulation, and is now recognized as an efficient treatment for hepatocellular carcinoma or metastatic tumor of the liver, with equivalent results to hepatic resection. However, when the tumor is located just below the top of the diaphragmatic dome, MCT via laparotomy requires a large incision, and percutaneous MCT is sometimes impossible because of the technical limitation of ultrasound known as ‘dead’ space. To perform MCT for a liver tumor arising just below the top of the diaphragmatic dome in a safe and less invasive manner, a procedure of MCT using a thoracoscope (thoracoscopic transdiaphragmatic MCT) has been reported. However, the skill to perform thoracoscopic surgery and special devices are essential for this technique. An adission of mini-thoracotomy just above the site of the tumor ought to make it easy to perform MCT in these cases. We performed MCT for 7 cases with liver tumors located just below the top of the diaphragmatic dome using thoracoscopic-assisted procedure with a mini-thoracotomy (video assisted thoracoscopic MCT, VATMCT). Here we present this technique and our preliminary results.
Three cases with unresectable liver cancer treated with intraoperative microwave coagulation were reported in this article. Case 1 : 61-year-man with a severe hepatic dysfunction, operated for HCC in S3, was found to have another small HCC in S8 which was treated by intraoperative microwave coagulation. Case 2 : 63-year-man with a severe hepatic dysfunction was treated by intraoperative microwave coagulation for a huge HCC in S5-8 with additional chemolipiodol therapies. Case 3 : 53-year-woman had liver (S4) and lung metastases after resection of rectal cancer. Liver lesion was treated by intraoperative microwave coagulation combined with chemotherapies for lung metastases. All these cases are alive after the microwave coagulation for 33, 18 and 24 months respectively with no regrowth of liver tumors. No severe complications were observed except liver dysfunctions in all cases. This therapy was considered to be useful clinically for unresectable liver cancer.
From December 1994 to December 1997, 19 patients with liver cancer were undergone microwave coagulo-necrotic therapy (MCT). Nine patients were treated with MCT only, but the other 10 patients were treated by MCT combined with hepatic resection or PEIT or TAE. The approach of MCT were laparotomy (n = 15), thoracotomy (n = 1), laparoscopy (n = 3). In 19 patients, 26 nodules were treated by MCT. Twenty three nodules (88%) became complete tumor necrosis, and 3 nodules failed in complete necrosis. Post-operative complications were seen in 3 patients. These included pleural effusion in 2 patients, ascites and icterus in 1 patient. There was no operative mortality. Thus, we concluded that MCT can be effective, useful and safe therapeutic modality for liver cancer. But it was thought that MCT must be treated more carefully in some situations.
Gastrointestinal leiomyosarcoma usually results in repeated liver metastases or peritoneal disseminations during a long clinical course. Considering the therapeutic strategies for these liver metastases other than operative hepatic resection, percutaneous ethanol injection therapy (PEIT) or transcatheteric arterial embolization (TAE) may be not very effective due to the tumor's solidity and hypovascularity. Recently, microwave coagulonecrotic therapy (MCT) is becoming familiar as one of the strategies for liver tumors. We performed percutaneous MCT (PMCT) and open MCT consecutively for one case of an unresectable second recurrent metastatic liver tumor of gastric leiomyosarcoma and were able to control the growth of the tumor. In our present strategy for liver metastases of leiomyosarcoma, small metastases under 2 cm in diameter are treated by PMCT or open MCT, but for large metastatic tumors, hepatectomy should be chosen in cases in which operative curability can be expected. In terms of quality of life, it is possible to employ open MCT aggressively for huge metastatic liver tumors that can not be resected for anatomical reasons.
Recently, the symptoms related to gastric hypersecretion in patients with Zollinger-Ellison syndrome (ZES) can be well controlled with histamine receptor antagonists or proton pump inhibitors. The radical treatment for patients with ZES is complete resection of the primary and metastatic tumor. However, metastatic liver tumors from the primary region, especially those occupying the hepatic hilum, are difficult to resect completely due to neighboring important vessels such as the portal vein or hepatic artery. We report a 52-year-old man showing ZES. He had a solitary metastatic tumor near the hepatic hilum, although the primary gastrinoma could not be detected in the pancreas or duodenum even by selective arterial secretin injection test (SASI test) or various diagnostic images. Transcatheteric arterial embolization therapy for the metastatic liver tumor had not controlled the tumor growth effectively, but open microwave coagulation therapy (MCT) for the metastatic liver tumor could decrease the serum level of gastrin and the tumor size remarkably. This case indicates that the MCT is able to improve the prognosis of the patients with unresectable liver metastases of neuroendocrine tumors.
We experienced a case of breast cancer with liver metastases performed with radical mastectomy for the primary mammary lesion and microwave coagulation therapy (MCT) for the metastatic lesions in the liver simultaneously. On the laparotomy, four lesions were detected in S4 and in S3 of the liver. One lesion in S3 was resected for histological examination, and the others were treated with MCT. After the operation systemic chemotherapy (CEF) with hormone therapy was adapted. Postoperative course was good except for the liver abscess, which was formed in S4, just the same site ablated with MCT. By drainage of the liver abscess, both the abscess cavity and the symptom were disappeared. No report about simultaneous MCT for the hepatic metastases together with radical mastectomy was seen in the literature. We expect this strategy in one of the options for breast cancer with liver metastasis.
A 59-year-old man was operated on with abdominoperineal exsion for rectal cancer. A single liver metastsis, pulmonary metastses and local recurrence of rectal cancer were detected postoperatively. Microwave coagulation therapy (MCT) was performed to the liver metastsis 8 cm in diameter. In the prone position on the CT table under epidural anesthesia, the local recurrence with invasion upon the prostata was coagulated 80 W for 30-45 seconds 7 times with microwave tissue coagulator 1 year after the operation. Area of the coagulated tissue including a part of the prostata invaded by the tumor was about 50% of the local recurrence on the CT images. There was evidence of relapse of the local recurrence after the therapy because complete coagulation was not obtained. Through this case, we report the effect and limitation of the CT guided MCT for local recurrence of rectal cancer.
Microwave coagulo-necrotic Therapy (MCN) has been applied widely to not only hepatocellular carcinoma but also metastatic hepatic carcinoma, as an established form of surgical therapy. We performed MCN for patients who have a liver metastasis lesion following surgery on bile duct cancer and who have hepatic invasion form gallbladder cancer. The formations of liver abscess were observed one month after MCN. Strong involvement of the choledochojejunostomy were suspected although there direct cause were fistulation with intrahepatic bile ducts. Care should be exercised in indicating MCN for patients who have undergone a reconstructive operation of the biliary tract.
A 52-year-old man experienced open microwave coagulation therapy (MCT) for hepatocellular carcinoma (HCC) in S5 of the cirrhotic liver related to HBV. Main tumor was 25 mm in diameter with an adjacent 20 mm satellite tumor. Continuous 5Fu-CDDP arterial infusion was required because of bilobar multiple recurrence 4 months after the open MCT. Fortunately, the patient is alive without disease 17 months after surgery under complete response to the arterial infusion chemotherapy. Although MCT is one of good choice for treatment of poor risk HCC patients, care should be taken not to mobilize the tumor and to add effective adjuvant chemotherapies especially in advanced cases.
AIM : This study evaluated the effects of Microwave Coagulation Therapy (MCT) for the malignant biliary obstruction. PATIENTS and METHODS : Five patients were bile duct cancer and one was pancreas cancer. Coagulation and hyperthermic treatment through PTBD fistula was performed using a coaxial cable with 1.8 mm spherical shaped probe or a 5.0 mm bullet shaped probe. MCT was continued once a week with 5.0 mm bullet shaped probe twice. RESULT : Biliary obstruction could be recanalized by MCT in all patients without any complications. Two patients, who treated with MCT for the first treatment using 5 mm bullet shaped probe. They are survived for seventeen months with no symptom. CONCLUSION : MCT is clinically feasible for the recanalization of the malignant biliary obstruction, in addition to the local control of the tumor growth.
Endoscopic microwave coagulation therapy (EMCT) was performed the pancreato-biliary carcinoma with malignant biliary obstruction. There were 10 cases (mean age 71.7 yr) including 6 of bile duct carcinoma, 2 cases of carcinoma of the gallbladder and pancreas, 2 cases of the carcinoma of the Vater papilla. The microwave irradiation of 50W / 10-second or 40W / 15-second was delivered to the carcinoma under cholangioscopy or duodenoscopy. Patency of the biliary obstruction was achieved in all cases after the treatment, and no severe complications were encountered. There out of 7 cases survived for more than one year without jaundice. The present study suggests that EMCT has a beneficial effect on maintaining patency of the bile duct for the treatment of malignant biliary obstruction, resulting in prolonging the patient survival.
We evaluated the size of irradiated regions after percutaneous microwave coagulation therapy (PMCT) to determine the optimal irradiation time in proportion to the tumor size in hepatocellular carcinoma (HCC). We reviewed the findings on dynamic CT within 5 days and one month after PMCT for 23 lesions in 20 patients with HCC. The tumor area was irradiated with microwaves for 2 to 9 minutes according to the tumor size. There was correlation between the size of hypoattenuation area after the treatment and irradiation time. Hyperattenuation surrounding the hypoattenuation area was frequently observed within 5 days after PMCT and made it difficult to evaluate the anti-tumor effect exactly. The finding almost disappeared one month after PMCT and we should evaluate the effect of treatment with dynamic CT in both periods.
A 64-year-old man was diagnosed as having a hepatocellular carcinoma (HCC) which was 10mm in diameter. It was revealed by computed tomography (CT), magnetic resonance imaging (MRI) and angiography, however, it could not be detected by conventional ultrasonography. For the purpose of detecting the lesion during the operative procedure, we used CO2-ultrasonography (CO2-US). CO2-US successfully demonstrated the site of the lesion both preoperatively and intraoperatively. CO2-US is an efficacious and less invasive imaging modality for thoraco or laparoscopic microwave coagulo-necrotic therapy (MCN), when the lesion can not be detected by conventional ultrasonography.