Transhepatic artery chemoembolization combined with percutaneous and laparoscopic microwave coagulation for massive hepatocellular carcinoma

Abstract

Objective To investigate the value of transhepatic artery chemoembolization (TACE) combined with percutaneous and laparoscopic microwave coagulation in treating unresectable massive hepatocellular carcinoma(HCC). Methods Clinical data of 1 patient with massive right lobe HCC in Department of Hepatobiliary Surgery, Sun Yat-sen Memorial Hospital of Sun Yat-sen University on 24th October, 2011 were retrospectively analyzed. The patient was male and 67 years old. The level of alpha-fetoprotein (AFP) was 1975 μg/L, indocyanine green retention rate at 15 min (ICG15) was 0.29, and the Child-Pugh liver function grading was grade A. The computed tomography (CT) examination showed a massive HCC in the right lobe of liver with a metastasis in the segment Ⅵ. Liver resection was unable to performed because of the poor liver reserve function, so comprehensive treatments of TACE+ microwave coagulation were planned to performed. The informed consent of the patient was obtained and the ethical committee approval was received. Results Active preparation was made after admission in hospital. The patient received TACE on 3rd November, 2011 and 20th December, 2011 respectively. The level of AFP still kept increasing to 18 797 μg/L after TACE. And CT reexamination showed iodinated oil deposition in the right lobe HCC and necrosis of major part of tumor tissues. In consideration of residual tumor cells, the patient received percutaneous and laparoscopic microwave coagulation on 17th February, 2012. The liver function of the patient was stable at Child-Pugh grade A during the whole treatment. The level of AFP decreased rapidly to 5930 μg/L 1 week after microwave coagulation and returned to a normal level 2 months after treatment. CT reexamination showed the HCC lessened evidently compared with the one before treatment. No recurrence of HCC was observed during the follow-up till the submission date. Conclusions For unresectable massive HCC, TACE combined with percutaneous and laparoscopic microwave coagulation is a safe and effective therapeutic regimen. Key words: Carcinoma, hepatocellular; Chemoembolization, therapeutic; Microwaves; Laparoscopes