A case of thoracoscopic microwave coagulonecrotic therapy for hepatocellular carcinoma with intraoperative percutaneous ethanol injection therapy

Abstract

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.