The analysis of the usefulness of laparoscopic microwave coagulation therapy for hepatocellular carcinoma in patients with poor hepatic reserve by serial measurements of IL-6, cytokine antagonists, and C-reactive protein.
BACKGROUND
Little is known about the effectiveness of laparoscopic microwave coagulation therapy (L-MCT) for hepatocellular carcinoma (HCC) in patients with liver cirrhosis and poor hepatic reserve. Here, we analyzed the usefulness of laparoscopic MCT by comparing the serum levels of IL-6, cytokine antagonists, and C-reactive protein (CRP) following L-MCT with those following MCT with the open method (O-MCT).


METHODS
Sixteen patients with hepatocellular carcinoma (HCC) were separated into L-MCT and O-MCT groups according to ICGR15 (ICGR15 30%<:L-MCT, 30%> :O-MCT). Nine patients with poorer hepatic reserve received L-MCT, while seven patients with relatively good hepatic reserve received O-MCT. Serum levels of cytokine antagonists (interleukin-6, IL-6; interleukin-1 receptor antagonist, IL-1ra; soluble tumor necrosis factor receptor type I, sTNF-R55) and C-reactive protein (CRP) were simultaneously measured on serial postoperative days (POD) by immunoassay.


RESULTS
Postoperative serum levels of IL-6, IL-1ra, and CRP were significantly elevated on POD-1 and returned to the preoperative levels on POD-7 in both L-MCT and O-MCT groups. In contrast, no significant elevation of sTNF-R55 was found during the period in both groups. In addition, no statistical differences were found in the levels of IL-6, IL-1ra, sTNF-R, and CRP between the groups, except that the level of IL-6 on POD-1 in L-MCT group was significantly lower than that in the O-MCT group.


CONCLUSIONS
These results suggested that the surgical stress by L-MCT in patients with poorer hepatic reserve were almost equal to that by O-MCT in patients with relatively good hepatic reserve, indicating the usefulness of L-MCT for HCC patients with poorer hepatic reserve. We recommend the laparoscopic approach for future patients with the criterion that ICGR15 is over 30%.
Sadamori
H
H
Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine and Dentistry, 2-5-1 Shikata, Okayama 700-8558, Japan. sada@md.okayama-u.ac.jp
Yagi
T
T
Kanaoka
Y
Y
Morimoto
Y
Y
Inagaki
M
M
Ishikawa
T
T
Matsukawa
H
H
Matsuda
H
H
Iwagaki
H
H
Tanaka
N
N
D002097:C-Reactive Protein / Q000032:analysis*; D006528:Carcinoma, Hepatocellular / Q000097:blood / Q000473:pathology / Q000532:radiotherapy*; D016207:Cytokines / Q000097:blood; D005260:Female; D006521:Hepatitis, Chronic; D006801:Humans; D053590:Interleukin 1 Receptor Antagonist Protein; D015850:Interleukin-6 / Q000097:blood*; D010535:Laparoscopy / Q000379:methods*; D008113:Liver Neoplasms / Q000097:blood / Q000473:pathology / Q000532:radiotherapy*; D008297:Male; D008872:Microwaves / Q000627:therapeutic use*; D008875:Middle Aged; D011028:Pneumoperitoneum, Artificial; D012189:Retrospective Studies; D012795:Sialoglycoproteins / Q000097:blood*; D018709:Statistics, Nonparametric; D014409:Tumor Necrosis Factor-alpha / Q000032:analysis*
D016207:Cytokines; C507763:IL1RN protein, human; D053590:Interleukin 1 Receptor Antagonist Protein; D015850:Interleukin-6; D012795:Sialoglycoproteins; D014409:Tumor Necrosis Factor-alpha; D002097:C-Reactive Protein