The long-term outcomes of small hepatocellular carcinoma (HCC) 2 cm or less in diameter were almost the same between surgery and ablation by comparison under sub-grouping according to the liver function, the number of the tumors, and the degree of differentiation. Therefore, surgery or ablation are equally selectable for the treatment method for 2 cm or less sized-HCC. On the other hand, for HCC from 2.1 cm to 3.0 cm in diameter, surgery is recommended because the long-term outcome of surgery was significantly better than that of ablation. In HCC 2 cm or less in size, the survival of the patients who underwent systematic resection was significantly better than that of the patients with non-systematic resection. However, the factor of "systematic or non-systematic" was not an independent prognostic factor by multivariate analysis using Cox's proportional hazards model.
This article introduces the current state with regard to indications, results, and complications of percutaneous ablation therapy for hepatocellular carcinoma and the problems that should be solved in the future are described.
68 patients with hepatocellular carcinoma were treated with laparoscopic microwave coagulation therapy between April 1995 and February 2003 at our institution. For these 68 case, we analyzed prognostic factors contributing to survival with univariate and multivariate analysis. When the survival rate was assessed for all patients treated with laparoscopic microwave coagulation, one-year survival was 97%, three-year survival was 81%, and five-year survival was 43%. On univariate analysis, only histology was a significant factor for survival. And on multivariate analysis, whether the therapy was primary or secondary HCC strongly influenced survival.
Since July 1994, MCN has been used for patients with hepatocellular carcinoma (HCC) in our institute. All our new patients were classified by a new prognostic staging system, modified JIS score, combined liver damage grades (A, B, and C) and TNM staging by the Liver Cancer Study Group of Japan criteria (stage 0-IV). In the m-JIS score 1 group, cumulative 1-, 3-, and 5-year survival rates in MCN group were 98.3, 87.6, 73.3%, and in hepatic resection (Hr) group were 100, 86.8, 65.1% (p = 0.8550). In the m-JIS score 2 group, cumulative 1-, 3-, and 5-year survival rates in MCN group were 98.9, 86.4, 76.2%, and in Hr group were 79.7, 58.9, 58.9% (p = 0.0001). In the m-JIS score 3 group, cumulative 1-, 3-, and 5-year survival rates in MCN group were 94.3, 61.4, 36.0%, and in Hr group were 88.9, 71.1, - % (p = 0.9393). In each m-JIS score group, cumulative 1-, 3-, and 5-year survival rates in MCN group and in Hr group were compared. And no difference of survival rates between MCN group and Hr group in each m-JIS score groups was noted. In conclusion, MCN can be a first choice for the treatment of HCC.
JIS scores, an integrated staging system for hepatocellular carcinoma (HCC) that combines degree of tumor advancement and the reserve capability of the liver, and said to excel in stratifying patient prognoses. In this study, we used 867 HCC patients to compare, according to their JIS scores, the prognosis among patients given percutaneous microwave coagulation therapy (PMCT), hepatic resection, and percutaneous ethnaol injection therapy (PEIT). The results showed that, among subjects whose JIS score was 0 points, those who underwent PMCT (n = 28) had a 5-year survival rate of 85% ; the rate for those who underwent liver resection (n = 35) was 72% ; and the rate for those who underwent PEIT (n = 36) was 82%, showing no differences. However, the 5-year non-recurrence rate was 49% for the liver resection group, 39% for the PMCT group, and 7% for the PEIT group, showing better rates for the liver resection group (p < 0.01) and the PMCT group (p < 0.05) than the PEIT group. Based on the above, it was suggested that Stage I HCC patients were good candidates for PMCT.
In our institute, hepatic resection and/or MCN have been used for HCC. This study assesses the efficacy of these treatments, especially for small HCC measuring 2 cm or less in greatest diameter. From July 1994 to March 2004, 60 patients with small HCC underwent hepatic resection (Hr) and/or MCN (Hr, 3; MCN, 55; Hr + MCN, 2). The cumulative 1-, 3-, and 5-year survival rates in MCN group were 100, 97.0, 91.6%, in Hr group were 100, 100, 100%, and in Hr + MCN group were 100, 100, - %. The cumulative 1-, 3-, and 5-year survival rates of Liver damage (LD)-A group were 100, 100, 100%, of LD-B group were 100, 100, 92.3%, and of LD-C group were 100, 0% (p < 0.0001). In conclusion, both Hr and MCN, especially MCN are the effective local treatment for small HCC with LD A or B.
In recent years, the number of patients on ablation therapy for hepatocellular carcinoma (HCC) is on the rise. However, in this type of cancer with exposure on the liver surface, the risk of dissemination has been pointed out. We consider laparoscopic hepatectomy (LHx) to be particularly applicable to those avoidable, less invasive cases with a high risk of dissemination. Thus, we investigated LHx availability for HCC exposed on the liver surface. MATERIALS AND METHODS : Among all 49 patients undergoing LHx, we examined 10 cases with liver surface exposure for tumor position, diameter, preoperative hepatic function, operating time, hemorrhage amount, etc. RESULTS : LHx was undertaken in 10 patients with HCC exposure on the liver surface. In terms of safety, the outer area, S6, etc. were limited to the peripheral area. With improvement in surgical skills, operating time and blood loss have been reduced by this treatment so as to allow earlier discharge.
The possible use of microwave tissue coagulation therapy (MCT) for metastatic liver tumor was studied. The subjects were 13 patients with one or a few metastatic liver tumors less than 4 cm in diameter. All patients were received chemotherapy concurrently. Their primary lesions were 7 gastric, 2 mammary, 2 colorectal, and 2 pancreatic cancers. The MCT was performed at the output of 30W for 90 seconds under percutaneous route or 60W for 45 seconds under laparotomy. We judged complete coagulation of the tumor using Enhanced CT one week later the irradiation. Only 3 local recurrence was recognized in the completely coagulated area and median disease free interval was 8 months (3 to 66 months). Their survivals were from 4 to 56 months and 50% median survival time (MST) was 15 months. The prognosis was especially poor in the patients with pancreatic cancer. Thus, these results suggest that MCT can be a useful tool as a local therapy in the multidisciplinary treatments for patients with metastatic liver tumor.
Purpose : Radiofrequency Ablation (RFA) for liver tumor is remarkably spreading as alternative therapeutic option. However, the efficacy and long-term results are unknown. We have evaluated our experiences of RFA in 63 patients of hepatocellular carcinoma (HCC) and metastatic liver tumor (MLT) from August 2000 to June 2004. Methods : We performed RFA under general anesthesia with Cool-tipTM System (RADIONICSTM). The approach and position depends on the tumor location. Results : Percutaneous RFA was performed in 42 patients and laparotomy RFA in 9. Hepatectomy was done simultaneous in 6 cases and another operation such as gastrectomy in 9. Mean observative period was 18.0 months. Local recurrence rate was 17.9% and 33.3%, repectively. One-and 2-year survival ratio of HCC were 94.0% and 76.0%. And also in case of MLT were 90.4% and 72.0%, respectively. The incidence of major complication was liver infarction in one case. Conclusion : RFA therapy is feasible and valuable therapy for HCC and MLT. To decrease recurrence, refinement of procedures and instruments should be required.
As a transurethral treatment, we have performed microwave coagulation therapy for urinary bladder cancer. We applied this method to small recurrent tumor of an outpatient. Under epidural anesthesia of sacral region, the cystoscope with an external 22.5-french sheath is inserted. The bladder is filled with physiological saline, and inner cavity is examined. For histological diagnosis, biopsy is performed at first. The microwave applicator with a 2.5 mm outside diameter is inserted from the working channel, and it is placed close to the tumor. Then microwave is irradiated 20 seconds with the energy of 100W. The catheter indwelling is not needed after operation. Transurethral microwave coagulation therapy is also useful for small tumors of outpatients.
Partial nephrectomy was performed on 21 kidneys out of 20 patients using a microwave tissue coagulator. The diagnosis was renal tumor and renal stones in 16 and 4 patients, respectively. Renal tumors were less than 4 centimeters in diameter, except one patient with a tumor of eight centimeters in a single kidney. Excision of the tumors was done via the retroperitoneal approach through an lumbar oblique incision. Vascular clamping was necessary in two patients to reduce bleeding. Although urine leakage was seen postoperatively in three patients (14.3%), it ceased spontaneously at 14 and 23 days after surgery in two of them. In the other patient with a large renal tumor extending to the renal hilum, urine leakage continued for 43 days, although double J ureteral catheter was placed postoperatively. In three patients (14.3%), atrophy of the renal parenchyma occurred gradually after surgery and function was eventually lost in two of them. Diffuse renal atrophy seemed to be completed during four to six months after the surgery. Major postoperative complications using microwave tissue coagulator were the urine leakage and the renal atrophy. To avoid these complications, non-protruding or large renal tumor should be excluded for the indication. However, thermal injury to the renal parenchyma or large vessels might be sometimes difficult to predict.
Partial nephrectomy is often selected for surgical treatment of small renal cell carcinoma (RCC) with its favorable prognosis. To determine the therapeutic outcome of partial nephrectomy using microwave tissue coagulator (MTC), we evaluated our series of 129 patients with T1 RCC who underwent this procedure. In 121 open surgery cases, no significant deterioration of the renal function as indicated by creatinine clearance was observed. the5-year overall-survival rate was 91% during a mean follow-up period of 40 months, and 106 patients were alive without disease. One patient showed local recurrence two years later. In eight laparoscopic surgery cases, no patient showed local recurrence. We concluded that non-ischemic partial nephrectmy using MTC is a useful nephron-sparing surgery for small RCC in terms of the prognosis and the postoperative renal function.
Microwave endometrial ablation (MEA) is a low invasive technique for menorrhagia resistant to conservative therapy. Since preliminary results of microwave endometrial ablation at a frequency of 9.2 GHz were published in 1995, it has been widely used as an alternative to hysterectomy for treating menorrhagia. The authors have developed a thin curved microwave applicator radiating microwaves at 2.45 GHz, which was applicable to an enlarged uterus with a distorted uterine cavity more than 12 cm in length ; a situation that had been a contraindication for conventional endometrial ablation. More than 50 Japanese women with menorrhagia underwent MEA using the curved applicator. Menorrhagia was improved in all patients and no major complication was encountered. MEA using the curved microwave applicator could safely treat organic menorrhagia in an enlarged uterus with a distorted cavity as well as dysfunctional menorrhagia. Most of hysterectomy for organic menorrhagia caused by non-malignant conditions such as submucous myoma or adenomyosis, may be avoidable by MEA.
PURPOSE : Since about 1960, there have been attempts to control the bleeding volume in hypermenorrhea by endometrial ablation using cryotherapy, thermal balloon therapy, or laser/high frequency wave therapy. However, these methods have problems such as the risk of uterine perforation and the necessity for skills. In recent years, microwave endometrial ablation (MEA) has been reported as a simple, safe, and accurate method. We used hysteroscopy in combination with MEA to detect residual portions after ablation and increase treatment effects and safety. METHODS : This method was performed with approval of the ethical committee at our department in 10 females (age40-49 years) with hypermenorrhea after obtaining informed consent. RESULTS : Slight menstrual bleeding was observed in 1 patient, but amenorrhea was observed in the other 8, and symptoms improved. There were no complications such as uterine perforation or injury of visceral organs. CONCLUSIONS : MEA performed in combination with hysteroscopy is a safe and effective method.
The case is a 67-year-old female who was treated with low anterior resection for rectal cancer in April 1998. Two years later, metastasis to lung was diagnosed and we performed left upper lobectomy. In another three years after the treatment, tracheal tumor was found. We diagnosed it was metastasis of past rectal cancer because the histological findings were similar to metastasis of past rectal cancer to lung. We performed microwave tissue coagulation (MTC) to the tracheal metastasis. The tumor was easily cauterized and removed. Two years have passed after the latest treatment and the tracheal metastasis of carcinoma has been favorably controlled. We concluded that microwave coagulation therapy (MCT) was a very effective method as a partial treatment for metastatic tracheal tumor.
Self expandable metallic stent (SEMS) is useful as choices of the cure for malignant esophagus strictures. But, the use of SEMS to strictures of the cervical and the abdominal esophagus deviates from adaptation. Microwave coagulation therapy (MCT) in the upper intestinal fiberscopy area is used for stopping bleeding purpose. We selected MCT as a remedy manner other than SEMS, it was useful.