A Role of Laparotomic Microwave Coagulation Therapy for Hepatocellular Carcinoma as a Less Invasive Surgery

Koji Maezawa, Takemasa Midorikawa, Gaku Kigawa, Kazuyoshi Ishibashi, Toshiyuki Hatakeyama, Kiyoshi Miyakawa, Hiroshi Nemoto, Hidehumi Yagi¹⁾, Yutaka Sanada and Mitsuo Kusano²⁾

Department of Surgery, Showa University Fujigaoka Hospital
Department of Surgery, Showa Hospital¹⁾
Second Department of Surgery, Showa University School of Medicine²⁾

Purpose: The smaller degree of invasiveness and the radicality of laparotomic microwave coagulation therapy (LMCT) for hepatocellular carcinoma (HCC) were statistically evaluated compared with hepatectomy. Methods: Subjects were 72 patients with HCC undergoing LMCT or hepatectomy from 1997 to 1999. They were divided into patients receiving LMCT (M group, n=35) and patients receiving hepatectomy (R group, n=37). The background of the patients and tumors, staging, functional hepatic reserve, general liver functions, the factors of surgical stress, the time course of liver function, inflammatory markers before and after surgery, operative results, the survival rate, and the prognostic factors were evaluated statistically between the groups. Results: The diameter of tumor was greater and the rate of association with cirrhosis was significantly lower in the R group than in the M group. The levels of ICG R15, GSA LHL15, Alb, PT and T-Bil were significantly worth in the M group than in the R group. Operative bleeding in the factors of surgical stress were significantly lower in the M group than in the R group. The time course before and 2 weeks after surgery of the levels of AST and ALT was higher and the levels of CRP and IL-6 were significantly lower in the M group than in the R group. The inclinable correlation between the level of IL-6 on the first operative day and bloodloss during surgery, the level of IL-6 on the first operative day and relative hepatic resected volume, operative time and relative hepatic resected volume were significantly correlated. The operative results and the changes of the levels of AFP between the groups showed no significant difference. The rate of survival between the groups showed no significant difference. Conclusion: LMCT for the HCC patients with impaired liver function decreased the operative bleeding and surgical stress significantly without any sacrifices in the complication rate, local control of the tumor, or the survival rate. LMCT should be considered as a safe, less invasive, and more reliable local treatment for these patients, if the patient can not be received hepatic resection.

Key words
hepatocellullar carcinoma, hepatectomy, microwave coagulation therapy, liver tumor ablation, less invasive surgery

Reprint requests
Takemasa Midorikawa Department of Surgery, Showa University Fujigaoka Hospital
1-30 Fujigaoka, Aoba-Ku, Yokohama, 227-8501 JAPAN

Accepted
November 30, 2004

To read the PDF file you will need Abobe Reader installed on your computer.