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Initial Experience of Surgical Microwave Tissue Precoagulation in Liver Resection for Hepatocellular Carcinoma in Cirrhotic Liver

Amr Abdelraouf, Hussam Hamdy, Hussin Ezzat, Ahmed Mohamed Abdelaziz Hassan and Magdy M Elsebae

Background: Surgical Hepatic resection has been considered as the first-line treatment which is most effective and radical treatment for hepatocellular carcinoma in cirrhotic liver. However, hepatic resection, in the presence of cirrhosis is associated with high risk of hemorrhage; thus, good clinical results can only be achieved by minimizing operative blood loss. The tremendous progress in microwave technology has recently attracted considerable attention. Here we describe the treatment outcomes achieved at our institution for intraoperative use of the microwave tissue precoagulation in hepatic resection as part of our strategy for the treatment of HCC.

Methods: Twenty-six selected patients received elective hepatic resections using intraoperative microwave tissue precoagulation as their initial therapy for hepatocellular carcinoma in cirrhotic liver. The patients who were enrolled for our study were chosen according to the Barcelona criteria for HCC management. The safety, therapeutic effect and recurrence were prospectively evaluated and analyzed.

Results: All the procedures were completed as planned. The median duration of the operation was 118 (range, 65-250) minutes with a median resection time of 45 (range 30-80) minutes. The median blood loss for resection was 165 (range, 100-750) mL. One patient required blood transfusion. The average time taken to coagulate the anticipated liver transection plane was less than 15 min. There was no operative mortality. The median postoperative hospital stay was 6 days. The median follow-up of patients was 14 months. At last follow up, recurrent tumors were noted in three (11.5%) of the patients (local in one and remote in two of the patients).

Conclusion: Our initial results show that surgical microwave tissue precoagulation in liver resection for hepatocellular carcinoma in cirrhotic liver is safe and effective treatment. It achieves an acceptable recurrence rate. Longer follow-up is required to determine the long-term outcome of this new treatment modality.