Five-year Survival of Patients with Hepatocellular Carcinoma Treated with Laparoscopic Microwave Coagulation Therapy

Background and Study Aim: Hepatocellular carcinomas (HCCs) that are located near the liver surface are difficult to treat with percutaneous locoregional therapies, so we have performed laparoscopic microwave coagulation therapy (LMCT) for these HCCs. We assessed the long-term survival of patients with HCCs treated with LMCT, the factors related to their survival, and the rates and causes of local and distant recurrences.
Patients and Methods: Participants were 68 patients with HCC treated in the past 8 years with LMCT under local or general anesthesia. LMCT was done using microwave electrodes with tips ranging from 15 to 45 mm in length; the effectiveness of LMCT was confirmed using contrast-enhanced computed tomography (CT) within 2 weeks of the LMCT procedure while patients were still in hospital, and within 1 - 3 months after the procedure in an outpatient setting; and the follow-up study was performed periodically by CT, ultrasonography, or magnetic resonance imaging (MRI) in addition to estimation of alpha fetoprotein. Factors contributing to survival were analyzed statistically.

Results: The mean lengths of the major and minor axes of the 71 HCC nodules in 68 patients were 20 mm and 18 mm, respectively, and the mean lengths of the major and minor axes of the coagulated areas were 43 mm and 29 mm, respectively. At dynamic CT after the LMCT procedure, treatment in 62 of the 68 patients (91 %) was judged to have been completely effective; the remaining six patients underwent additional therapy while still in hospital. Eight of the 68 patients (12 %) had local recurrences, 39 of them (57 %) had distant recurrences, and 21 of them (31 %) had no recurrence up to December 31 2003. A total of 14 patients (21 %) died during the 16 - 56 months after LMCT. When the survival rate was assessed for all patients treated with LMCT, 1-year survival was 97 %, 3-year survival was 81 %, and 5-year survival was 43 %. Whether the therapy was for primary or secondary HCC strongly influenced survival.

Conclusions: LMCT is a useful modality in clinical practice for treatment of HCC nodules located near the liver surface, and it can be safely performed, in its entirety, under direct visual guidance.

References

• 1 Bosch F X, Ribes J, Borras J. Epidemiology of primary liver cancer.  Semin Liver Dis. 1999;  19 271-285
• 2 El-Serag H B, Mason A C. Rising incidence of hepatocellular carcinoma in the United States.  N Engl J Med. 1999;  340 745-750
• 3 Sherlock S, Dooley J. Hepatic tumors. In: Sherlock S, Dooley J (eds) Diseases of the liver and biliary system. 8th edn. Oxford; Blackwell Scientific Publications 1993: 503-531
• 4 Poon R T-P, Fan S-T, Tsang F H-F, Wong J. Locoregional therapies for hepatocellular carcinoma: a critical review from the surgeons’s perspective.  Ann Surg. 2002;  235 466-486
• 5 Livraghi T, Goldberg S N, Lazzaroni S. et al . Small hepatocellular carcinoma: treatment with radiofrequency ablation versus ethanol injection.  Radiology. 1999;  210 655-661
• 6 Curley S A, Izzo F, Ellis L M. et al . Radiofrequency ablation of hepatocellular cancer in 110 patients with cirrhosis.  Ann Surg. 2000;  232 381-391
• 7 Izumi N, Asahina Y, Noguchi O. et al . Risk factors for distant recurrence of hepatocellular carcinoma in the liver after complete coagulation by microwave or radiofrequency ablation.  Cancer. 2001;  91 949-956
• 8 Dromain C, Baere T, Elias D. et al . Hepatic tumors treated with percutaneous radio-frequency ablation: CT and MR imaging follow-up.  Radiology. 2002;  223 255-262
• 9 Iannitti D A, Dupuy D E, Mayo-Smith W W, Murphy B. Hepatic radiofrequency ablation.  Arch Surg. 2002;  137 422-427
• 10 Komorizono Y, Oketani M, Sako K. et al . Risk factors for local recurrence of small hepatocellular carcinoma tumors after a single session, single application of percutaneous radiofrequency ablation.  Cancer. 2003;  97 1253-1262
• 11 Seki S, Sakaguchi H, Kadoya H. et al . Laparoscopic microwave coagulation therapy for hepatocellular carcinoma.  Endoscopy. 2000;  32 591-597
• 12 Arii S, Yamaoka Y, Futagawa S. et al . Results of surgical and nonsurgical treatment for small-sized hepatocellular carcinomas: a retrospective and nationwide survey in Japan. The Liver Cancer Study of Japan.  Hepatology. 2000;  32 1224-1229
• 13 Ebara M, Ohto M, Sugiura N. et al . Percutaneous ethanol injection for the treatment of small hepatocellular carcinoma of 95 patients.  J Gastro Hepatol. 1990;  5 616-626
• 14 Seki T, Wakabayashi M, Nakagawa T. et al . Ultrasonically guided percutaneous microwave coagulation therapy for small hepatocellular carcinoma.  Cancer. 1994;  74 817-825
• 15 Morimoto M, Sugimori K, Shirato K. et al . Treatment of hepatocellular carcinoma with radiofrequency ablation: Radiologic-histologic correlation during follow-up periods.  Hepatology. 2002;  35 1467-1475
• 16 Wood B J, Ramkaransingh J R, Foji T. et al . Percutaneous tumor ablation with radiofrequency.  Cancer. 2002;  94 443-451
• 17 de Baere T, Bessoud B, Dromain C. et al . Percutaneous radiofrequency ablation of hepatic tumors during temporary venous occlusion.  AJR Am J Radiol. 2002;  178 53-59
• 18 Yamaoka Y, Ikai I, Arii S. et al . The Liver Cancer Study of Japan. 16th nationwide survey on primary liver cancer in Japan (2000 - 2001).  Acta Hepatol Jpn. 2005;  46 234-254 [In Japanese]
• 19 Muto Y, Moriwaki H, Ninomiya M. et al . Prevention of second primary tumors by an acyclic retinoid, polypyrenoic acid, in patients with hepatocellular carcinoma.  N Engl J Med. 1996;  334 1561-1567
• 20 Li Z-Q, He F-Y, Stehle C J. et al . Vitamin K uptake in hepatocytes and hepatoma cells.  Life Sci. 2002;  70 2085-2100
• 21 Kato J, Kobune M, Nakamura T. et al . Normalization of elevated hepatic 8-hydroxy-2'-deoxyguanosine levels in chronic hepatic C patients by phlebotomy and low iron diet.  Cancer Res. 2001;  61 8697-8702
• 22 Matsui Y, Uhara J, Satoi S. et al . Improved prognosis of postoperative hepatocellular carcinoma patients when treated with functional foods: a prospective cohort study.  J Hepatol. 2002;  37 78-86
• 23 Shina S, Ishikawa T, Omato M. Treatment with percutaneous radiofrequency ablation for hepatic tumors.  Acta Hepatol Jpn. 2004;  45 (Supp1 2) A392 [In Japanese]