Ultrasound-Guided Microwave Coagulation Assisted Anatomical Resection of the Cirrhotic Liver: A Matched Pair Analysis

Abstract

Background: Systematic hepatectomy for small hepatocellular carcinoma (HCC) is a widely preferred modality, but major hepatectomy is limited due to hepatic functional reserve in cirrhotic patients. In hepatic resection, especially in cirrhotic patients, we propose the new technique that ultrasound (US)-guided microwave coagulation (MC) to Glissonean pedicle before parenchymal transection in order to control in-flow and to decide resection area. The aim of this study is to introduce our new procedure and to evaluate the outcome of the patients treated by the technique. Patients and Methods: Procedure: Coagulation of the Glissonean pedicles feeding the segment or unit to be resected was induced by introduction of microwave coagulation under us-guidance. The intrahepatic parenchymal change induced by the microwave was monitored using color-doppler mode (Figure). Then demarcation line was appeared at liver surface, and color-doppler revealed inflow to the lesion was disappeared. After microwave coagulation, parenchymal dissection was performed. Patients: Twelve patients with HCC were enrolled (MC group). Four patients were liver cirrhosis and others were chronic hepatitis. All patients were underwent anatomical resection such as subsegmentectomy or cone-unit resection by us-guided Glisson coagulation technique (Subsegmentectomy; S8: 2, S7: 1, S6: 2, S5: 1, Cone-unit resection; S8: 4, S7: 1, S5: 1). MC group were compared in a retrospective analysis with a historical group of 10 patients who underwent conventional operation, less than subsegmentectomy in same period (Control group). Two groups were well matched age, tumor size and location, type of hepatic resection. Results: The mean operative time was similar in both groups (MC group: 253 min [174-323], Control group: 273 min [154-388]). The mean blood loss in MC group was less than Control group, with significance difference (174 ml [23-620] vs 286 ml [50-409], p<0.05). Incidence of postoperative complication was similar in both groups. In MC group, minor bile leakage was observed in one patient, but no critical complication was occurred such as postoperative bleeding or liver abscess. Postoperative recurrence was occurred in 4 patients in MC group, however, local recurrence was not observed. Conclusion: US-guided Glissonean coagulation before transection made the area of discoloration on the liver surface obvious, and by this technique the inflow blood to the tumor was intercepted. Our procedure is feasible to perform anatomical resection safely and easily, and is possible to inhibit intrahepatic metastasis via portal flow during transection.