Thoracoscopic transdiaphragmatic microwave coagulation therapy for a liver tumor.
BACKGROUND
Microwave coagulation therapy (MCT) for hepatocellular carcinoma, which induces tumor coagulonecrosis, is now recognized as an efficient treatment. However, when a tumor is located just below the top of the diaphragmatic dome, laparotomical MCT requires a large incision, and percutaneous MCT is sometimes impossible.


METHODS
The patients were four men and two women. There were four cases of hepatocellular carcinoma and two cases of liver metastasis from colorectal cancer. All tumors were located below the top of the diaphragmatic dome. Thoracoscopic transdiaphragmatic MCT (TTMCT) was performed under general anesthesia using an endotracheal double-lumen tube. Identification of the tumor site in the liver was performed using an ultrasonic probe under thoracoscopic observation. After the diaphragm above the tumor was opened, a needle electrode to transmit microwaves was inserted directly into the tumor. Microwave irradiation was repeated to coagulate the entire lesion. After completion of TTMCT, the diaphragm was closed thoracoscopically.


RESULTS
TTMCT was successfully administered to cancerous lesions in all six patients. The postoperative course was uneventful, and the average postoperative hospitalization period was 10.5 days. None of the patients has shown any recurrence during a follow-up period of 4-23 months.


CONCLUSIONS
TTMCT was performed without any difficulty using the thoracoscopic surgical technique, and its therapeutic outcome was satisfactory. This is effective for tumors located just below the top of the diaphragmatic dome.
Yamashita
Y
Y
Second Department of Surgery, Fukuoka University School of Medicine, 7-45-1 Nanakuma, Jonan-ku, Fukuoka City 814-80, Japan.
Sakai
T
T
Maekawa
T
T
Watanabe
K
K
Iwasaki
A
A
Shirakusa
T
T
D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D003964:Diaphragm / Q000601:surgery; D004564:Electrocoagulation / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008113:Liver Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D008297:Male; D008872:Microwaves / Q000627:therapeutic use*; D008875:Middle Aged; D013906:Thoracoscopy; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome