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Published in: Journal of Hepato-Biliary-Pancreatic Sciences 3/2013

Open Access 01-03-2013 | Original article

Evaluation of intraoperative microwave coagulo-necrotic therapy (MCN) for hepatocellular carcinoma: a single center experience of 719 consecutive cases

Authors: Yuko Takami, Tomoki Ryu, Yoshiyuki Wada, Hideki Saitsu

Published in: Journal of Hepato-Biliary-Pancreatic Sciences | Issue 3/2013

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Abstract

Background

Hepatic resection (HRx) or radiofrequency ablation may be carried out as the first-line treatment of hepatocellular carcinoma (HCC). However, we have used intraoperative microwave ablation, named microwave coagulo-necrotic therapy (MCN) as part of our strategy for the treatment of HCCs for more than 15 years. Here we describe the treatment outcomes achieved at our institution as a high-volume center for microwave ablation.

Methods

Between July 1994 and December 2010, 719 consecutive patients received MCN as their initial therapy for HCC (mean tumor size 26.9 mm, mean number of lesions 2.51) at our institute. The therapeutic survival effect, local tumor progression, and overall recurrence were prospectively evaluated and statistically analyzed.

Results

The 1-, 3-, 5-, 7-, and 10-year overall survival rates of all 719 patients were 97.7, 79.8, 62.1, 45.3, and 34.1 %, respectively. Thirty percent of the patients had Child–Pugh class B cirrhosis and the 5-year survival rate of these patients was 46.6 %. The 5-year survival of patients with ≥4 lesions (n = 168) was 49.6 % and that of patients meeting the Milan criteria (n = 470) was 70.9 %. The 1-, 3-, 5-, 7-, and 10-year overall survival rates for 390 patients treated with MCN who had ≤3 lesions with diameter ≤3 cm were 97.9, 85.1, 70.0, 57.1, and 43.0 %. No significant differences were found between the overall survival rates after MCN and the overall survival rates in 34 patients treated with HRx during the same period at our institute and under the same (P = 0.3592), nor were there any differences in disease-free survival (P = 0.3496) and local recurrence rates between the MCN and HRx groups (P = 0.5926).

Conclusion

MCN is effective for the locoregional control of HCC, with results comparable to those of HRx. MCN should be considered as one of the first-choice treatments for HCC, even for patients with poor liver function or multiple lesions.
Literature
1.
go back to reference Takayama T, Makuuchi M, Hirohashi S, Sakamoto M. Early hepatocellular carcinoma as an entity with a high cure rate of surgical cure. Hepatology. 1998;28:1241–6.PubMedCrossRef Takayama T, Makuuchi M, Hirohashi S, Sakamoto M. Early hepatocellular carcinoma as an entity with a high cure rate of surgical cure. Hepatology. 1998;28:1241–6.PubMedCrossRef
2.
go back to reference Majima Y, Tanikawa K. Percutaneous ethanol injection therapy (PEIT) for small hepatocellular carcinoma smaller than 30 mm in diameter. Jpn J Med Ultrasonics. 1991;18:S41–2. Majima Y, Tanikawa K. Percutaneous ethanol injection therapy (PEIT) for small hepatocellular carcinoma smaller than 30 mm in diameter. Jpn J Med Ultrasonics. 1991;18:S41–2.
3.
go back to reference Pearson AS, Izzo F, Fleming RYD, Ellis LM, Delrio P, Roh MS, et al. Intraoperative radiofrequency ablation or cryoablation for hepatic malignancies. Am J Surg. 1999;178:592–8.PubMedCrossRef Pearson AS, Izzo F, Fleming RYD, Ellis LM, Delrio P, Roh MS, et al. Intraoperative radiofrequency ablation or cryoablation for hepatic malignancies. Am J Surg. 1999;178:592–8.PubMedCrossRef
4.
go back to reference Livraghi T, Goldberg SN, Lazzaroni S, Meloni F, Solbiati L, Gazalle GF. Small hepatocellular carcinoma: treatment with radio-frequency ablation versus ethanol injection. Radiology. 1999;210:655–61.PubMed Livraghi T, Goldberg SN, Lazzaroni S, Meloni F, Solbiati L, Gazalle GF. Small hepatocellular carcinoma: treatment with radio-frequency ablation versus ethanol injection. Radiology. 1999;210:655–61.PubMed
5.
go back to reference Tateishi R, Shiina S, Teratani T, Obi S, Sato S, Koike Y, et al. Percutaneous radiofrequency ablation for hepatocellular carcinoma. An analysis of 1000 cases. Cancer. 2005;103:1201–9.PubMedCrossRef Tateishi R, Shiina S, Teratani T, Obi S, Sato S, Koike Y, et al. Percutaneous radiofrequency ablation for hepatocellular carcinoma. An analysis of 1000 cases. Cancer. 2005;103:1201–9.PubMedCrossRef
6.
go back to reference N’Kontchou G, Mahamoudi A, Aout M, Ganne-Carrie N, Grando V, Coderc E, et al. Radiofrequency ablation of hepatocellular carcinoma: long-term results and prognostic factors in 235 western patients with cirrhosis. Hepatology. 2009;50:1475–83.PubMedCrossRef N’Kontchou G, Mahamoudi A, Aout M, Ganne-Carrie N, Grando V, Coderc E, et al. Radiofrequency ablation of hepatocellular carcinoma: long-term results and prognostic factors in 235 western patients with cirrhosis. Hepatology. 2009;50:1475–83.PubMedCrossRef
7.
go back to reference Livraghi T, Meloni F, Di Stasi M, Rolle E, Solbiati L, Tinelli G, et al. Sustained complete response and complications rates after radiofrequency ablation of very early hepatocellular carcinoma in cirrhosis: is resection still the treatment of choice? Hepatology. 2008;47:82–9.PubMedCrossRef Livraghi T, Meloni F, Di Stasi M, Rolle E, Solbiati L, Tinelli G, et al. Sustained complete response and complications rates after radiofrequency ablation of very early hepatocellular carcinoma in cirrhosis: is resection still the treatment of choice? Hepatology. 2008;47:82–9.PubMedCrossRef
8.
go back to reference Tabuse K. A new operative procedure of hepatic surgery using a microwave tissue coagulator. Arch Jpn Chir. 1979;48:160–72. Tabuse K. A new operative procedure of hepatic surgery using a microwave tissue coagulator. Arch Jpn Chir. 1979;48:160–72.
9.
go back to reference Saitsu H, Yoshida M, Taniwaki S, Sato H, Okami N, Okuda Y, et al. Laparoscopic coagulo-necrotic therapy using Microtase for small hepatocellular carcinoma. Jpn J Gastroenterol. 1991;88:2727. Saitsu H, Yoshida M, Taniwaki S, Sato H, Okami N, Okuda Y, et al. Laparoscopic coagulo-necrotic therapy using Microtase for small hepatocellular carcinoma. Jpn J Gastroenterol. 1991;88:2727.
10.
go back to reference Seki T, Wakabayashi M, Nakagawa T, Imamura M, Tamai T, Nishimura A, et al. Percutaneous microwave coagulation therapy for patients with small hepatocellular carcinoma. Cancer. 1999;85:1694–702.PubMedCrossRef Seki T, Wakabayashi M, Nakagawa T, Imamura M, Tamai T, Nishimura A, et al. Percutaneous microwave coagulation therapy for patients with small hepatocellular carcinoma. Cancer. 1999;85:1694–702.PubMedCrossRef
11.
go back to reference Rossi S, Di Stasi M, Buscarini E, Cavanna L, Quaretti P, Squassante E, et al. Percutaneous radio frequency interstitial thermal ablation in the treatment of small hepatocellular carcinoma. Cancer J Sci Am. 1995;1:73–81.PubMed Rossi S, Di Stasi M, Buscarini E, Cavanna L, Quaretti P, Squassante E, et al. Percutaneous radio frequency interstitial thermal ablation in the treatment of small hepatocellular carcinoma. Cancer J Sci Am. 1995;1:73–81.PubMed
12.
go back to reference Shibata T, Iimuro Y, Yamamoto Y, Maetani Y, Ametani F, Itoh K, et al. Small hepatocellular carcinoma: comparison of radio-frequency ablation and percutaneous microwave coagulation therapy. Radiology. 2002;223:331–7.PubMedCrossRef Shibata T, Iimuro Y, Yamamoto Y, Maetani Y, Ametani F, Itoh K, et al. Small hepatocellular carcinoma: comparison of radio-frequency ablation and percutaneous microwave coagulation therapy. Radiology. 2002;223:331–7.PubMedCrossRef
13.
14.
go back to reference Liang P, Dong B, Yu X, Yu D, Wang Y, Feng L, et al. Prognostic factors for survival in patients with hepatocellular carcinoma after percutaneous microwave ablation. Radiology. 2005;235:299–307.PubMedCrossRef Liang P, Dong B, Yu X, Yu D, Wang Y, Feng L, et al. Prognostic factors for survival in patients with hepatocellular carcinoma after percutaneous microwave ablation. Radiology. 2005;235:299–307.PubMedCrossRef
15.
go back to reference Martin RCG, Scoggins CR, McMasters KM. Safety and efficacy of microwave ablation of hepatic tumors: a prospective review of a 5-year experience. Ann Surg Oncol. 2010;17:171–8.PubMedCrossRef Martin RCG, Scoggins CR, McMasters KM. Safety and efficacy of microwave ablation of hepatic tumors: a prospective review of a 5-year experience. Ann Surg Oncol. 2010;17:171–8.PubMedCrossRef
16.
go back to reference Bhardwaj N, Strickland A, Ahmed F, El-Abassy M, Morgan B, Robertson GSM, et al. Microwave ablation for unresectable hepatic tumours: clinical results using a novel microwave probe and generator. Eur J Surg Oncol. 2010;36:264–8.PubMedCrossRef Bhardwaj N, Strickland A, Ahmed F, El-Abassy M, Morgan B, Robertson GSM, et al. Microwave ablation for unresectable hepatic tumours: clinical results using a novel microwave probe and generator. Eur J Surg Oncol. 2010;36:264–8.PubMedCrossRef
17.
go back to reference Skinner MG, Iizuka MN, Kolios MC, Sherar MD. A theoretical comparison of energy sources—microwave, ultrasound and laser—for interstitial thermal therapy. Phys Med Biol. 1998;43:3535–47.PubMedCrossRef Skinner MG, Iizuka MN, Kolios MC, Sherar MD. A theoretical comparison of energy sources—microwave, ultrasound and laser—for interstitial thermal therapy. Phys Med Biol. 1998;43:3535–47.PubMedCrossRef
18.
go back to reference Wright AS, Sampson LA, Warner TF, Mahvi AM, Lee FT. Radiofrequency versus microwave ablation in a hepatic porcine model. Radiology. 2005;236:132–9.PubMedCrossRef Wright AS, Sampson LA, Warner TF, Mahvi AM, Lee FT. Radiofrequency versus microwave ablation in a hepatic porcine model. Radiology. 2005;236:132–9.PubMedCrossRef
19.
go back to reference Takada Y, Kurata M, Ohkohchi N. Rapid and aggressive recurrence accompanied by portal tumor thrombus after radiofrequency ablation for hepatocellular carcinoma. Int J Clin Oncol. 2003;8:332–5.PubMedCrossRef Takada Y, Kurata M, Ohkohchi N. Rapid and aggressive recurrence accompanied by portal tumor thrombus after radiofrequency ablation for hepatocellular carcinoma. Int J Clin Oncol. 2003;8:332–5.PubMedCrossRef
20.
go back to reference Llovet JM, Vilana R, Bru C, Bianchi L, Salmeron JM, Boix L, et al. Increased risk of tumor seeding after percutaneous radiofrequency ablation for single hepatocellular carcinoma. Hepatology. 2001;33:1124–9.PubMedCrossRef Llovet JM, Vilana R, Bru C, Bianchi L, Salmeron JM, Boix L, et al. Increased risk of tumor seeding after percutaneous radiofrequency ablation for single hepatocellular carcinoma. Hepatology. 2001;33:1124–9.PubMedCrossRef
21.
go back to reference Ruzzenente A, Manzoni GD, Molfetta M, Pachera S, Genco B, Donataccio M, et al. Rapid progression of hepatocellular carcinoma after radiofrequency ablation. World J Gastroenterol. 2004;10:1137–40.PubMed Ruzzenente A, Manzoni GD, Molfetta M, Pachera S, Genco B, Donataccio M, et al. Rapid progression of hepatocellular carcinoma after radiofrequency ablation. World J Gastroenterol. 2004;10:1137–40.PubMed
22.
go back to reference Kotoh K, Morizono S, Kohjima M, Enjoji M, Sakai H, Nakamuta M. Evaluation of liver parenchymal pressure and portal endothelium damage during radio frequency ablation in an in vivo porcine model. Liver Int. 2005;25:1217–23.PubMedCrossRef Kotoh K, Morizono S, Kohjima M, Enjoji M, Sakai H, Nakamuta M. Evaluation of liver parenchymal pressure and portal endothelium damage during radio frequency ablation in an in vivo porcine model. Liver Int. 2005;25:1217–23.PubMedCrossRef
23.
go back to reference Kawamoto C, Yamauchi A, Baba Y, Kaneko K, Yakabi K. Measurement of intrahepatic pressure during radiofrequency ablation in porcine liver. J Gastroenterol. 2010;45:435–42.PubMedCrossRef Kawamoto C, Yamauchi A, Baba Y, Kaneko K, Yakabi K. Measurement of intrahepatic pressure during radiofrequency ablation in porcine liver. J Gastroenterol. 2010;45:435–42.PubMedCrossRef
24.
go back to reference Okusaka T, Okada S, Ueno H, Ikeda M, Shimada K, Yamamoto J, et al. Satellite lesions in patients with small hepatocellular carcinoma with reference to clinicopathologic features. Cancer. 2002;95:1931–7.PubMedCrossRef Okusaka T, Okada S, Ueno H, Ikeda M, Shimada K, Yamamoto J, et al. Satellite lesions in patients with small hepatocellular carcinoma with reference to clinicopathologic features. Cancer. 2002;95:1931–7.PubMedCrossRef
25.
go back to reference Wright AS, Lee FT, Mahvi DM. Hepatic microwave ablation with multiple antennae results in synergistically larger zones of coagulation necrosis. Ann Surg Oncol. 2003;10:275–83.PubMedCrossRef Wright AS, Lee FT, Mahvi DM. Hepatic microwave ablation with multiple antennae results in synergistically larger zones of coagulation necrosis. Ann Surg Oncol. 2003;10:275–83.PubMedCrossRef
26.
go back to reference Simon CJ, Dupuy DE, Iannitti DA, Lu DSK, Yu NC, Asward BI, et al. Intraoperative triple antenna hepatic microwave ablation. AJR Am J Roentgenol. 2007;187:W333–40.CrossRef Simon CJ, Dupuy DE, Iannitti DA, Lu DSK, Yu NC, Asward BI, et al. Intraoperative triple antenna hepatic microwave ablation. AJR Am J Roentgenol. 2007;187:W333–40.CrossRef
27.
go back to reference Lencioni RA, Allgaier HP, Cioni D, Olschewski M, Deibert P, Crocetti L, et al. Small hepatocellular carcinoma in cirrhosis: randomized comparison of radio-frequency thermal ablation versus percutaneous ethanol injection. Radiology. 2003;228:235–40.PubMedCrossRef Lencioni RA, Allgaier HP, Cioni D, Olschewski M, Deibert P, Crocetti L, et al. Small hepatocellular carcinoma in cirrhosis: randomized comparison of radio-frequency thermal ablation versus percutaneous ethanol injection. Radiology. 2003;228:235–40.PubMedCrossRef
28.
go back to reference Ikeda M, Okada S, Ueno H, Okusaka T, Kuriyama H. Radiofrequency ablation and percutaneous ethanol injection in patients with small hepatocellular carcinoma: a comparative study. Jpn J Clin Oncol. 2001;31:322–6.PubMedCrossRef Ikeda M, Okada S, Ueno H, Okusaka T, Kuriyama H. Radiofrequency ablation and percutaneous ethanol injection in patients with small hepatocellular carcinoma: a comparative study. Jpn J Clin Oncol. 2001;31:322–6.PubMedCrossRef
29.
go back to reference Kudo M, Chung H, Osaki Y. Prognostic staging system for hepatocellular carcinoma (CLIP score): its value and limitations, and a proposal for a new staging system, the Japan Integrated Staging Score (JIS score). J Gastroenterol. 2003;38:207–15.PubMedCrossRef Kudo M, Chung H, Osaki Y. Prognostic staging system for hepatocellular carcinoma (CLIP score): its value and limitations, and a proposal for a new staging system, the Japan Integrated Staging Score (JIS score). J Gastroenterol. 2003;38:207–15.PubMedCrossRef
30.
go back to reference Takayasu K, Arii S, Ikai I, Omata M, Okita K, Ichida T, et al. Prospective cohort study of transarterial chemoembolization for unresectable hepatocellular carcinoma in 8510 patients. Gastroenterology. 2006;131:461–9.PubMedCrossRef Takayasu K, Arii S, Ikai I, Omata M, Okita K, Ichida T, et al. Prospective cohort study of transarterial chemoembolization for unresectable hepatocellular carcinoma in 8510 patients. Gastroenterology. 2006;131:461–9.PubMedCrossRef
31.
go back to reference Liang P, Wang Y, Yu X, Dong B. Malignant liver tumors: treatment with percutaneous microwave ablation—complications among cohort of 1136 patients. Radiology. 2009;251:933–40.PubMedCrossRef Liang P, Wang Y, Yu X, Dong B. Malignant liver tumors: treatment with percutaneous microwave ablation—complications among cohort of 1136 patients. Radiology. 2009;251:933–40.PubMedCrossRef
Metadata
Title
Evaluation of intraoperative microwave coagulo-necrotic therapy (MCN) for hepatocellular carcinoma: a single center experience of 719 consecutive cases
Authors
Yuko Takami
Tomoki Ryu
Yoshiyuki Wada
Hideki Saitsu
Publication date
01-03-2013
Publisher
Springer Japan
Published in
Journal of Hepato-Biliary-Pancreatic Sciences / Issue 3/2013
Print ISSN: 1868-6974
Electronic ISSN: 1868-6982
DOI
https://doi.org/10.1007/s00534-012-0527-5

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