A case performed effectually thoracoscopic and open thoracotomic microwave coagulo-necrotic therapy for TAE resistant type of hepatocellular carcinoma recurrence

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Recurrent lesion of hepatocellular carcinoma (HCC-R) just below the dyaphragm which resists to transcatheter hepatic arterial embolization therapy (TAE) is also difficult to perform percutaneous ethanol injection therapy (PEI) according to its anatomical relationship. Recently, we have performed thoracoscopic and open thoracotomic microwave coagulo-necrotic therapy (MCN) on this type of HCC-R and successfully suppressed the proliferation of the tumor.The case was 62 years old man being HBV carrier. In June 1992, subsegmentectomy of the liver (S6) was performed for the HCC with liver cirrhosis. In August 1993, HCC-R was pointed out on S7, however, the resection of this lesion was considered to be impossible because of inadequate hepatic functional reserve. Therefore, TAE was performed and the control of tumorous proliferation was found to be incomplete. The third TAE performed in July 1994 was failed because its feeding right hepatic artery, which branched from superior mesenteric artery, was occulded by preceding TAE. In August 1994, after the identification of tumor-occupied lesion by the CT imaging, thoracoscopic MCN was performed for this intractable recurrent tumor. Preoperative intrathoracic 3-D reconstraction image produced by helical CT scan was useful for detection of infra-diaphragmatic tumorous location. However, an additional damage due to MCN may be induced on the right cardiac atrium and inferior vena cava which is neighboring the tumor, and thus the control of the tumor was still incomplete. In December 1994 another new HCC-R lesion was found near the previous treated part on S7, and open thoracotomic MCN therapy was performed again in June 1995. The follow-up CT image showed an adequate control of this tumor after three weeks of this operation.MCN is very useful in treating unresectable HCC, and it is suggested the possibility making up defects between surgical hepatic resection and other interventional therapy.