Microwave Coagulo-necrotic Therapy Research Articles

Hepatic resection versus operative microwave ablation for single hepatocellular carcinoma ≤5 cm: A propensity score-matched analysis

BackgroundLittle evidence exists regarding the perioperative and oncologic benefits of microwave ablation for hepatocellular carcinoma. The aim of this study was to compare the efficacy of hepatic resection and operative microwave ablation (microwave coagulo-necrotic therapy) for single hepatocellular carcinoma ≤5 cm. MethodsBetween 1994 and 2015, a total of 551 patients with a single hepatocellular carcinoma ≤5 cm were treated in our institution (hepatic resection: n = 128; microwave coagulo-necrotic therapy: n = 423). We compared overall survival and recurrence-free survival between hepatic resection and microwave coagulo-necrotic therapy. Propensity score matching analysis identified 94 matched pairs of patients to compare outcomes. ResultsAfter propensity score matching, baseline variables, including liver function and tumor size, were well-balanced between the 2 groups. The 5- and 10-year overall survival rates were 76% and 47% for hepatic resection and 77% and 48% for microwave coagulo-necrotic therapy, respectively (P = .865). The 5- and 10-year recurrence-free survival rates were 55% and 41% for hepatic resection and 47% and 32% for microwave coagulo-necrotic therapy, respectively (P = .377). In the subgroup analysis, the hepatic resection group had better recurrence-free survival than the microwave coagulo-necrotic therapy group in patients with tumor size >3 cm, with 5-year recurrence-free survival rates of 56.5% and 32.4% in the hepatic resection and microwave coagulo-necrotic therapy group, respectively (P = .029). ConclusionOur propensity score matching study confirmed no statistically significant differences in both overall survival and recurrence-free survival between hepatic resection and microwave coagulo-necrotic therapy for single hepatocellular carcinoma ≤5 cm; however, hepatic resection is recommended for hepatocellular carcinoma with tumor size >3 cm when patients have good liver function.

Long-term survival of a patient with recurrent gallbladder carcinoma, treated with chemotherapy, immunotherapy, and surgery: a case report

BackgroundGallbladder cancer (GBC) is one of the refractory diseases. Multidisciplinary approach including immunotherapy for such cancers has received much attention in recent years.Case presentationA 59-year-old man underwent an extended cholecystectomy for GBC (pathological stage II, T2 N0 M0, [per UICC 7th edition]) that was incidentally found during cholelithiasis surgery, and was then treated with adjuvant gemcitabine (GEM). Three months later, when a recurrence-suspected lesion was detected in segment 5 (S5) of his liver, we started adoptive immunotherapies with cytokine-activated killer (CAK) cell infusions, combined with chemotherapy. After a year of adjuvant immunochemotherapy, the S5 lesion disappeared on imaging, but lesions suspected metastatic recurrence again appeared in S7 and S8 at 4 years and 6 months post-surgery, for which GEM and cisplatin (CDDP) were administered as second-line chemotherapy. Immunochemotherapy produced stable disease (per RECIST) for 9 months, when tumor growth was detected; open microwave coagulo-necrotic therapy (MCN) was performed for these lesions. Three years after MCN, a solitary liver metastasis was detected in S4. MCN was conducted again, and peritoneal dissemination was found intraoperatively. A month after the second MCN, the patient’s carcinoembryonic antigen (CEA) level had increased. Therefore, GEM and tegafur-gimeracil-oteracil potassium (TS-1) were administered as third-line chemotherapy. We also switched the adoptive immunotherapy for tumor-associated antigen-pulsed dendritic cell-activated killer (DAK) cell immunotherapy. After nine courses of GEM and TS-1 administration, CEA had decreased to a normal level. At the time of reporting, 9 years and 6 months have passed since the initial surgery, and 18 months have passed since the peritoneal metastasis was detected. GEM and CDDP are currently administered as fourth-line chemotherapy because of re-increased CEA. Although an undeniable metastasis was found in his para-aortic lymph node, this patient visits our clinic regularly for immunotherapy.ConclusionWe here report a rare case of long-term survival of recurrent GBC well controlled by multidisciplinary therapy. Immunotherapy may be a promising modality among multidisciplinary methods for advanced cancer.

Simultaneous microwave coagulo-necrotic therapy (MCN) and laparoscopic splenectomy for the treatment of hepatocellular carcinoma with cirrhotic hypersplenism.

To establish the efficacy and safety of simultaneous microwave coagulo-necrotic therapy (MCN) and laparoscopic splenectomy (Lap-Sp) for the treatment of hepatocellular carcinoma (HCC) with cirrhotic hypersplenism. Seventeen patients with HCC and cirrhotic hypersplenism underwent simultaneous MCN and Lap-Sp at our institution between January, 2010 and July, 2015. Eight and nine patients had Child-Pugh class A and B liver cirrhosis, respectively. The median number of tumors ablated was 1 (range 1-7) and the median largest dimension of the resected lesions was 1.7cm (range 1.1-3.6cm). We analyzed postoperative complications and long-term outcomes retrospectively. The median operating time was 283min (range 197-418min) and the median blood loss was 125mL (range 5-1312mL). Postoperative morbidity and mortality rates were 29 and 0%, respectively. The median follow-up time after surgery was 22.5months (range 4.3-70.9months). The 1-, 3-, and 5-year disease-free survival rates were 68.8, 10.7, and 10.7%, respectively, and the 1-, 3-, and 5-year overall survival rates were 88.2, 75.6, and 63.0%, respectively. The findings of this study suggest that simultaneous MCN and Lap-Sp is safe and effective for treating HCC with cirrhotic hypersplenism.

Assessment of the treatment mainly using intraoperative microwave coagulo-necrotic therapy (MCN) for bilobar multiple hepatocellular carcinoma

Purpose: Embolization or chemotherapy is generally recommended for hepatocellular carcinoma (HCC) patients with 4 or more tumors. However, we consider intraoperative microwave coagulo-necrotic therapy (MCN) a useful treatment method with similar local management effects as hepatic resection (HR) and have aggressively used even for multiple bilobar HCC. Now we evaluated therapeutic results and report on the usefulness of this treatment. Patients and methods: Among a total of 2877 HCC patients treated surgically at our department from 1994 to 2014, 1182 patients were newly diagnosed with HCC. Among these, 174 patients with 4 or more HCC tumors in both lobes were included. Overall survival (OS), disease-free survival (DFS), liver function, and tumor features were evaluated. MCN was performed in 151 patients, HR+MCN in 21, and HR in 2. Results: The mean age of 174 patients was 67.4 years and 77.6% had hepatitis C. The mean tumor diameter of the main nodule was 29.6 mm. The 3-, 5-, and 10-year OS (%) of these patients were 72.9, 44.7, and 22.0, respectively. The 5 year-OS in Child-Pugh grade (CP) -A 126 patients was 50.0% and was significantly higher than that in CP-B patients (p = 0.0016). In the evaluation of individual markers, the 3-year/5-year OS of patients with PIVKA-II < 400 (78.3/49.4%) was significantly favorable than those with PIVKA-II ≥ 400 (35.2/17.6%) (P = 0.0002). Conclusion: MCN-based treatment strategies are useful in multiple HCC. Favorable liver function (CP-A) is necessary for long-term survival. Especially, surgical treatment should be selected for patients with PIVKA-II < 400.

Multimodal Treatment of Breast Cancer Liver Metastases Based on Hepatic Resection and Microwave Coagulo-Necrotic Therapy (MCN)

C l i n M e d International Library Citation: Takami Y, Eguchi S, Tateishi M, Ryu T, Mikagi K, et al. (2016) Multimodal Treatment of Breast Cancer Liver Metastases Based on Hepatic Resection and Microwave CoaguloNecrotic Therapy (MCN). Int J Cancer Clin Res 3:038 Received: December 11, 2015: Accepted: January 09, 2016: Published: January 11, 2016 Copyright: © 2016 Takami Y, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Takami et al. Int J Cancer Clin Res 2016, 3:038

Efficacy of surgical treatment using microwave coagulo-necrotic therapy for unresectable multiple colorectal liver metastases.

BackgroundFive or more colorectal liver metastases (CRLM) are considered marginally resectable and cannot be treated solely by hepatic resection (Hr). This study investigated the long-term effectiveness of surgical treatment using microwave coagulo-necrotic therapy (MCN) and/or Hr for marginally resectable or unresectable multiple CRLM.MethodsThis study retrospectively analyzed 82 consecutive CRLM patients with ≥5 CRLM who underwent MCN, Hr, or both, at our institution from 1994 to 2012. Presuming all CRLM were resected curatively, virtual remnant liver volume was calculated using preoperative computed tomography or magnetic resonance imaging. Virtual remnant liver volume <30% was defined as unresectable. Patients were divided into marginally resectable (Group Y; n=29) and unresectable (Group N; n=53). Overall and recurrence-free survival were assessed.ResultsMean maximum tumor diameter and tumor number were 3.1 and 6.0 cm in Group Y and 3.3 and 11.3 cm in Group N. Surgical methods included MCN (n=16), MCN+Hr (n=9), and Hr (n=4) in Group Y, and MCN (n=28) and MCN+Hr (n=25) in Group N. One- and 2-year recurrence-free survival rates were 38.0% and 22.8% in Group Y, and 18.9% and 3.8% in Group N (P=0.01). However, 1-, 3-, and 5-year overall survival rates of Group N (86.8%, 44.6%, and 33.7%, respectively) were similar to those of Group Y (82.8%, 51.4%, and 33.3%, respectively; P= not significant each).ConclusionMCN may improve survival for patients with unresectable multiple CRLM, similar to that in patients with marginally resectable multiple CRLM.

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

BackgroundHepatic 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.MethodsBetween 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.ResultsThe 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).ConclusionMCN 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.

肝切除とマイクロ波凝固壊死療法(MCN)を使い分けた胃癌肝転移に対する当科の治療成績の検討

We evaluated the effect of hepatic surgery, including microwave coagulo-necrotic therapy (MCN), for liver metastases from gastric cancer. Twenty-nine patients with gastric liver metastases underwent hepatic surgery in our institute between December 1997 and December 2011. Hepatic resection (HR) was performed in 13 patients, MCN in 9, and MCN in combination with HR in 7. The overall survival rates at 1-, 3-, and 5-years were 83.8%, 37.3%, and 31.1%, respectively. Five patients have survived with no recurrence for more than 5 years. One of the patients treated with MCN for 7 gastric liver metastases. In conclusion, MCN alone or MCN in combination with HR allow more patients with gastric liver metastases to become candidates for hepatic surgery and give the long-term survival.

Adaptive criteria of microwave coagulo-necrotic therapy (MCN) for colorectal liver metastases

Adaptive criteria of microwave coagulo-necrotic therapy (MCN) for colorectal liver metastases

Imaging of pancreatic serous cystadenocarcinoma

Serous cystadenocarcinoma of the pancreas is a rare but well-established entity. The origin of this disorder is speculative, and its evolution remains unclear. On imaging, the malignant behavior of the tumor is best supported by local invasion and/or distant metastasis. The histological characteristics of serous cystadenocarcinoma are indistinguishable from those of its benign counterpart, making the presence of invasion the sole criterion distinguishing the two. The prognosis is excellent even in the face of metastatic disease. We report a case of serous cystadenocarcinoma complicated by recurrent acute and chronic pancreatitis. Initially, no sign of malignancy was seen on imaging. Follow-up study revealed its malignant nature in the form of increased size, presence of duodenal invasion, and multiple liver metastases. The patient underwent Whipple resection with a jejunal Roux-en-Y conduit and microwave coagulonecrotic therapy for metastatic liver lesions. Histopathological examination of the resected specimen revealed a locally invasive cystadenocarcinoma with metastatic disease. One year afterward, the patient is alive with no evidence of progression.

Strategies for the treatment of hepatocellular carcinoma: HR and MCN

Purpose: To evaluate the prognostic impact of microwave coagulo-necrotic therapy (MCN) versus hepatic resection (HR) on patient survival after treatment for hepatocellular carcinoma (HCC). Materials & methods: Between July 1994 and December 2006, 1567 patients underwent hepatic surgery at our institute. Of these, 613 who received their initial therapy for HCC were analyzed. MCN was performed in 456 patients, hepatic resection (HR) in 111, and HR + MCN in 42. The remaining 4 patients were treated with laparotomic ethanol injection. We analyzed the therapeutic survival, local tumor progression and overall recurrence rates.Results: The cumulative survival rates for patients treated with MCN (mean tumor size, 28.2 mm; mean number of lesions, 2.62) were 97.5, 77.6, 58.7, and 37.3%, at 1, 3, 5 and 10 years, respectively. The 5-year survival rate was 58.7% after MCN and 56.4% after HR (p = 0.9480). The cumulative survival rates for 238 patients treated with MCN who had 3 or fewer lesions of ≤3 cm in diameter were 98.1, 85.2, 70.3 and 43.5% at 1, 3, 5 and 10 years,. There were no significant differences in cumulative survival (p = 0.7358), disease-free survival or local recurrence rates between patients treated with MCN versus those treated with HR. Of the 613 patients receiving their initial treatment, 319 had recurrences after an average of 639.6 days after operation; 61 of these had 4 or more recurrent lesions, while 204 patients could be treated with MCN (mean tumor size, 23.7 mm; mean number of lesions, 3.08). Conclusion: Our findings suggest that MCN is an effective treatment for loco-regional control of HCC and is comparable to HR. MCN is particularly suitable for the treatment of patients presenting with multiple tumors or tumor recurrence. We recommend that HR and MCN should both be considered as first-choice treatments for HCC.

Hepatic resection and loco-regional ablation therapy

Today I wish to lecture you about the hepatic resection and loco-regional ablation therapy of the treatments for hepatocellular carcinoma.Up until 1980's hepatic resection was thought a very risky attempt. But since then the technological advance for hepatic resection was remarkable and how to assess the liver function before the hepatic resection was improved.Now hepatic resection can be done safely for the patients with well-preserved liver function.The local ablation methods have been also developed. RFA (radio frequency ablation) is good at the treatment for HCC, especially for 3 or few HCC with 3 cm or less in diameter. And MCN (microwave coagulo-necrotic therapy) has the good ability of loco-regional control of HCC and it is especially suitable for the treatment with multiple tumors in initial or recurrent states.

Treatment for hepatocellular carcinoma: from the standpoint of the internal medicine

Hepatocellular carcinoma (HCC) is an important clinical issue in Japan because of high prevalence and poor prognosis. HCC is treated by surgical operation including liver transplantation, microwave coagulo-necrotic therapy, radiofrequency ablation (RFA), percutaneous ethanol injection therapy (PEIT) and/or transcatheter arterial chemoembolization (TACE). Recent advance in these treatments can improve the prognosis of HCC. HCC is, however, multi-centrically occurred based on liver cirrhosis and chronic hepatitis. Therefore, physicians should treat not only HCC but also liver cirrhosis and hepatitis to patients with HCC.

Effectiveness of microwave coagulo-necrotic therapy (MCN) for colorectal liver metastases in the caudate lobe

Aims: To clarify the effectiveness of microwave coagulo-necrotic therapy (MCN) as a surgical treatment for colorectal liver metastases to the caudate, which is anatomically difficult to treat.Patients and Methods: From 1994 to 2006, a total of 185 consecutive patients underwent surgical treatment for colorectal liver metastases and 14 (7.6%) were found to have caudate metastases. Two had isolated caudate metastases. For 12 of the 14 patients, MCN was performed, while hepatectomy was for the other two.Results: All tumors (7.1-35 mm in diameter) were completely ablated by MCN. Intraoperative bleeding of MCN was much less than that associated with hepatectomy. There was no morbidity associated with MCN. No local recurrence was noted in the caudate.Conclusion: MCN is markedly effective treatment for caudate metastases.

肝細胞癌の治療戦略

Between July 1994 and December 2005, 1,324 patients underwent hepatic surgery in our institute. Of these patients, 508 patients who received their initial therapy for HCC were analyzed this time. MCN (microwave coagulo-necrotic therapy) was performed in 369 patients, hepatic resection (Hr) was in 98, and Hr + MCN was in 38. The remaining 3 patients were treated with laparotomic ethanol injection.The 1-, 3-, 5-, and 10-year cumulative survival rates for patients treated with MCN (mean tumor size, 28.8mm ; mean number of lesion, 2.63 ; Liver Damage, A in 39.1%, B in 56.8%, and C in 4.1%) were 97.3%, 80.2%, 62.3%, and 35.1%, respectively. Five-year survival rate was 62.3% in MCN and 60.8% in Hr group (p = 0.6047). The 1-, 3-, and 5-year local recurrence rates with MCN were 1.8%, 4.3%, and 5.4%. and those with Hr were 1.1%, 4,1%, and 4.1% (p = 0.8990).The 1-, 3-, and 5-year cumulative survival rates for 109 patients, who had 4 or more tumors, were 95.0%, 69.0%, and 43.3%.The 3-, 5-, and 10-year cumulative survival rates for the liver damage-A-patients treated with MCN were 87.6%, 68.9%, and 31.6%. Those for the liver damage-B-patients with MCN were 77.2%, 59.5%, and 37.6%.Based on the above, it was suggested that MCN has the good ability of loco-regional control of HCC and it is less invasive to the patients, especially with multiple tumors and/or with severe liver function. Therefore, we recommend MCN as a first choice for the treatment of HCC.

肝癌の治療法の選択―肝細胞癌に対するｓｔａｇｉｎｇ ｓｃｏｒｅから見たＭＣＮと肝切除の選択―

Since July 1994, we have used microwave coagulo-necrotic therapy (MCN) for patients with hepatocellular carcinoma (HCC) in our institute. All our new patients were classified by prognostic staging system (CLIP score, JIS score, modified JIS score and Tokyo Score) and those survival rate were assessed.In each staging score, the cumulative survival rates in MCN group were almost equal to those in hepatic resection (Hr) group.Based on the above, it was suggested that MCN has the ability of loco-regional control of HCC and MCN can be a first choice for the treatment of HCC.

Surgical treatment with microwave coagulo-necrotic therapy (MCN) and/or hepatic resection for small hepatocellular carcinoma

In our institute, hepatic resection and/or MCN have been used for HCC. This study assesses the efficacy of these treatments, especially for small HCC measuring 2 cm or less in greatest diameter.From July 1994 to March 2004, 60 patients with small HCC underwent hepatic resection (Hr) and/or MCN (Hr, 3; MCN, 55; Hr + MCN, 2).The cumulative 1-, 3-, and 5-year survival rates in MCN group were 100, 97.0, 91.6%, in Hr group were 100, 100, 100%, and in Hr + MCN group were 100, 100, - %. The cumulative 1-, 3-, and 5-year survival rates of Liver damage (LD)-A group were 100, 100, 100%, of LD-B group were 100, 100, 92.3%, and of LD-C group were 100, 0% (p < 0.0001).In conclusion, both Hr and MCN, especially MCN are the effective local treatment for small HCC with LD A or B.

The indication and modification of hand assisted laparoscopic microwave coagulonecrotic therapy

Laparoscopic microwave coagulonecrotic therapy (LMCT) for hepatocellular carcinoma is applicable for the patient whose liver damage is Child B or better. The indication is limited to the tumor smaller than 4 cm in diameter and located just beneath the surface. Hand-assistance helps to approach the tumor adjacent to the diaphragm. The hand-manipulation of the liver presents the view of the upper side of the liver to the scope. Puncturing with the electrode and scanning with ultrasound is more precise and easier than that without hand-assistance. We recommend the use of hand-assistance for laparoscopic microwave ablation to the tumor under the dome. The four cases treated by LMCT are presented, including the recurrent cases after the other treatment such as percutaneous ablation therapy and/or trans-arterial embolization.

Therapeutic outcomes of open microwave coagulo-necrotic therapy (MCT) for hepatocellular carcinoma

We now evaluated our therapeutic outcomes of open microwave coagulo-necrotic therapy (MCT) for hepatocellular carcinoma (HCC). The subjects were 23 patients for whom we underwent open MCT from November 1992 to December 2000. Postoperative three-year survival rate in Stage III cases for which open MCT was performed was 45.5%. In a comparison of the cumulative survival rates, there is no significant difference between the cases of the open MCT and hepatic resection. Local recurrence of treated area was experienced in only one case. This result suggested that open MCT is good for local ablation therapy for HCC. However, we actually experienced the lethal complications such as hepatic failure and pyothorax. We must be careful for extending the indication of open MCT.

A case of open microwave coagulo-necrotic therapy (MCT) via the middle hepatic vein for metastatic liver tumor neighboring the paracaval portion

We experienced a patient who underwent open MCT with the needle advanced via the middle hepatic vein for a metastatic liver tumor neighboring the paracaval portion. Open MCT was performed under hepatic inflow and outflow block to reduce the cooling effect by the blood flow. The operation was uneventfully performed, and no complications such as massive hemorrhage from middle hepatic vein, pulmonary infarction nor congestion in the drainage area of middle hepatic vein occurred. There was no evidence of local recurrence and other intrahepatic or extrahepatic metastases within 11 months after the operation. In conclusion, open MCT under hepatic inflow and outflow block is effective for tumors adjacent to a major hepatic vein. There was no complication when open MCT was performed by penetrating a major hepatic vein.