Long-term outcome of hepatocellular carcinoma patients who underwent liver resection using microwave tissue coagulation.
OBJECTIVE
Our policy for the surgical treatment of hepatocellular carcinoma (HCC) has been to minimize the extent of liver resection using a microwave tissue coagulator (MTC) and to not perform Pringle's maneuver for the prevention of ischemic injury to the liver routinely. We verify the safety of liver resection using MTC in HCC patients with poor liver functional reserve, and clarify the long-term outcome of HCC patients who underwent curative resection using MTC.


METHODS
One hundred sixty-eight patients who underwent curative resection using MTC between 1992 and 2001 were divided into two groups according each patient's score in the Indocyanin Green Retension 15 Test (ICG-R15 test). The high (ICG-R15 values>20) and low ICG-R15 groups (ICG-R15 values<20) included 100 and 68 HCC patients, respectively. Clinical characteristics of each group were evaluated, and operative mortality and morbidity, as well as overall and disease-free survival rates, were compared between the two groups to determine risk factors for overall and disease-free survival.


RESULTS
Although there were significant differences in liver function-related parameters between the low and high ICG-R15 groups, no differences in surgical or tumor factors were found. No patients in this study developed post-operative liver failure, and there was no significant difference in morbidity between the low and high ICG-R15 groups. The overall survival rate of the low ICG-R15 group was significantly longer than the high ICG-R15 group (p=0.0003). Cox's multivariate analysis showed that an ICG-R15 value less than 20 was the only significant independent factor for overall survival. Disease-free survival rates in the low ICG-R15 group were significantly longer than in the high ICG-R15 group (p=0.0007). Multivariate analysis showed that serum albumin level and number of tumors were significant independent factors for disease-free survival.


CONCLUSIONS
The long-term outcome of HCC patients with low ICG-R15 following curative resection using MTC was acceptable. This procedure was safe even for patients with high ICG-R15.
Satoi
Sohei
S
Department of Surgery, Kansai Medical University, Osaka, Japan. satoi@hirakata.kmu.ac.jp
Matsui
Yoichi
Y
Kitade
Hiroaki
H
Yanagimoto
Hiroaki
H
Toyokawa
Hideyoshi
H
Yamamoto
Hidekazu
H
Hirooka
Satoshi
S
Kwon
A-Hon
AH
Kamiyama
Yasuo
Y
Hepatology. 1999 Dec;30(6):1434-40
10573522
World J Surg. 2004 Feb;28(2):166-72
14708050
Br J Surg. 1999 Feb;86(2):282-3
10100807
Hepatogastroenterology. 2005 Jul-Aug;52(64):1180-5
16001657
Ann Surg. 1908 Oct;48(4):541-9
17862242
Hepatogastroenterology. 2002 Nov-Dec;49(48):1649-51
12397755
Semin Liver Dis. 1999;19(3):271-85
10518307
Arch Surg. 1987 Oct;122(10):1166-71
3662798
Cancer. 1995 Feb 1;75(3):794-800
7530166
Hepatogastroenterology. 1999 May-Jun;46(27):1885-9
10430364
J Am Coll Surg. 1998 Dec;187(6):620-5
9849736
Ann Surg. 2000 Jul;232(1):10-24
10862190
J Hepatol. 2002 Jul;37(1):78-86
12076865
Ann Surg. 2002 Jan;235(1):27-30
11753039
Arch Surg. 2001 Aug;136(8):922-8
11485528
Ann Surg. 1999 Feb;229(2):216-22
10024103
Arch Surg. 2002 Jan;137(1):94-9
11772225
Ann Surg. 2000 Apr;231(4):544-51
10749616
World J Surg. 1999 Oct;23(10):1032-7
10512943
Ann Surg. 2003 Apr;237(4):536-43
12677151
Hepatol Res. 2004 Jan;28(1):21-29
14734147
Eur J Surg Oncol. 1995 Apr;21(2):183-7
7720893
J Hepatobiliary Pancreat Surg. 1998;5(2):165-72
9745083
Ann Surg. 2005 Dec;242(6):814-22, discussion 822-3
16327491
J Am Coll Surg. 2005 Feb;200(2):308-13
15664110
Arch Surg. 2007 Jul;142(7):596-602; discussion 603
17638795
World J Surg. 1996 Oct;20(8):1076-81
8798367
Ann Surg. 2006 Mar;243(3):321-8
16495695
J Hepatobiliary Pancreat Surg. 1998;5(2):184-91
9745086
Ann Surg. 2002 Nov;236(5):560-3
12409660
Br J Surg. 1982 Feb;69(2):93-4
7059775
World J Surg. 1985 Feb;9(1):136-43
3984365
Hepatology. 2005 Nov;42(5):1208-36
16250051