[The echo-guided interstitial laser photocoagulation of malignant liver tumors. The authors' personal technic, immediate results and short-term complications in patients with normal and altered liver function].
OBJECTIVE
The literature studies about interstitial laser photocoagulation of liver tumors mainly deal with the treatment of liver metastasis in patients with normal liver function. We report our personal experience with interstitial laser photocoagulation in patients with liver tumors (mostly cirrhotics with hepatocellular carcinoma). Our aim was to evaluate the short term efficacy of percutaneous interstitial laser photocoagulation in inducing focal ablation of liver tumors and the possible complications in patients with normal and impaired liver function.


METHODS
Sixty-six patients (52-80 years; 42 men), 47 with 51 hepatocellular carcinoma nodules (diameter = 1.6-6.6 cm; mean 3.1 cm) on cirrhosis (18 in Child-Pugh A class, 24 in B e 5 in C class) and 19 patients with single liver metastasis (17 from colon, 2 from lung carcinoma; diameter = 3.9 cm; mean: 4.5 cm) underwent interstitial laser photocoagulation under ultrasound guidance. Depending on tumor size up to four needles were inserted in the tumor and multiple laser illuminations were performed: in nodules < or = 2 cm a single optical fiber and a single needle insertion were used, in nodules > 2 < 3 cm, 2-3 fibers were used with a single laser illumination, in nodules > 3 < 4 cm, 4 fibers were inserted and two laser illuminations were performed in the same session after 1.5 cm withdrawal of all fibers in the tumor, in nodules > 4 cm 2 sessions with 2 laser illuminations per session were performed. Necrosis of the nodules was evaluated with triphasic Helical CT 7 days after treatment. Patients with incomplete necrosis at CT were treated with additional interstitial laser photocoagulation sessions to attain complete necrosis.


RESULTS
Fifty-eight patients underwent a single interstitial laser photocoagulation session, 7 patients 2 session and 1 patient 3 sessions. The range of administered energy per patient was 1200-32,000 Joules (mean: 6700 J). CT showed complete necrosis of 47 nodules in 43 patients with hepatocellular carcinoma and in 15/18 patients with metastasis. Three Child C class patients with mild ascites and hyperbilirubinemia before procedure (nodules O: 1.9, 3.5 and 5.8 cm) dropped out of CT follow-up because of severe liver function impairment with increased ascites and hyperbilirubinemia, associated with transient ileum paraliticus in 1 case. One of these patients died two months after treatment. Two patients with metastasis dropped out of treatment because of complications occurred after the interstitial laser photocoagulation session (1 ileum paraliticus, 1 gastric hemorrhage) and another one refused to continue the treatment.
Giorgio
A
A
Servizio di Ecografia ed Ecointerventistica, Azienda Ospedaliera D. Cotugno, Napoli. assanui@infinito.it
Tarantino
L
L
De Stefano
G
G
Farella
N
N
Catalano
O
O
Cusati
B
B
Del Viscovo
L
L
Alaia
A
A
D000368:Aged; D000369:Aged, 80 and over; D001707:Biopsy, Needle; D006528:Carcinoma, Hepatocellular / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D006801:Humans; D017075:Laser Coagulation / Q000295:instrumentation / Q000379:methods*; D008099:Liver / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D008113:Liver Neoplasms / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000556:secondary / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional