A new approach to microwave coagulation therapy for hepatocellular carcinoma under biliary tract cooling via endoscopic naso-biliary drainage tube

Abstract

We devised a method of percutaneous microwave coagulation therapy (PMCT) for hepatic tumor under biliary cooling via an endoscopic naso-biliary drainage (ENBD) tube. A 60-year-old woman was admitted to the Kumamoto University Hospital. She was diagnosed as having a well-differentiated hepatocellular carcinoma in size 20 x 17 mm, which was located adjacent to the Glisson capsule of the posterior segment of the liver. The patient had the further complication of liver cirrhosis related to hepatitis C virus in clinical stage II. The hepatic tumor was treated with microwave coagulation therapy via a percutaneous approach. Five microwave exposures were carried out using percutaneous monopolar electrodes (1.6 mm wide and 25 cm long). The microwave frequency utilized was 2,450 MHz with an output power of 60 W for 30 sec. Biliary tract cooling was performed by repetitive irrigation with cold saline through the ENBD tube during PMCT. Postoperative transient elevation of the patient's serum amylase level followed PMCT; but consequently returned to normal levels. Postoperative contrast-enhanced CT images showed an unenhanced area (30 mm in size) at the therapeutic site that was larger than the tumor prior to treatment. No vascular injury was encountered. Neither biliary stricture nor dilatation have been detected by magnetic resonance cholangio-pancreatography (MRCP). The patient is alive without tumor recurrence 6 months after PMCT. In conclusion, this technique is useful for preventing biliary and vascular injury during PMCT for hepatic tumors adjacent to the Glisson capsule.