Surgical Department, National Hepatology & Tropical Medicine Research Institute (NHTMRI), Cairo, Egypt.
Radiodiagnosis Department, Faculty of Medicine, Menoufia University, Menoufia, Egypt.
J Gastrointest Cancer. 2021 Sep;52(3):892-898. doi: 10.1007/s12029-020-00477-x.
Hepatocellular carcinoma (HCC) is one of the most common malignancies and is the third cause of cancer-related death worldwide. Surgery is the optimal treatment for early HCC; however, the majority of cases are not suitable for curative resection at the time of diagnosis. Surgical resection difficulties may be related to size, site, number of tumors, extrahepatic involvement, and patient general condition. Exophytic tumors were considered as relative contraindication for thermal ablation because of the risk of incomplete ablation or major complications as hemorrhage and seeding.
to evaluate the safety and efficacy of microwave ablation (MWA) of exophytic HCC in comparison with non-exophytic HCC.
Prospective comparative study carried on 30 patients having 30 exophytic (six of those patients had another non-exophytic lesion) and 32 patients having 44 non-exophytic HCC lesions (22 had single lesion, 8 patients had 2 lesions, and 2 patients had 3 lesions) within Milan criteria. All patients were child A or B, they were subjected to full clinical assessment, laboratory investigations, and radiological investigations. Laparoscopic assisted percutaneous MWA was the procedure of choice in our study for all patients either having exophytic or non-exophytic lesions using no-touch wedge technique for exophytic lesions and direct puncture for non-exophytic lesions.
Technical success was 100% in both groups, all lesions were completely ablated as confirmed by LIOUS. There were no major complications or perioperative mortality and low incidence of local tumor progression in both exophytic and non-exophytic groups.
Laparoscopic assisted MWA of exophytic HCC is safe and effective with comparable results to non-exophytic HCC. Exophytic HCC is not contraindication for MWA with proper technique selection.
肝细胞癌（HCC）是最常见的恶性肿瘤之一，也是全球癌症相关死亡的第三大原因。手术是早期 HCC 的最佳治疗方法；然而，大多数病例在诊断时并不适合根治性切除。手术切除的困难可能与肿瘤的大小、部位、数量、肝外侵犯和患者一般状况有关。外生型肿瘤被认为是热消融的相对禁忌证，因为存在消融不完全或大出血和播种等严重并发症的风险。
评估微波消融（MWA）治疗外生型 HCC 的安全性和有效性，并与非外生型 HCC 进行比较。
前瞻性对比研究纳入了 30 例患有 30 个外生型（其中 6 例患者还有另一个非外生型病变）和 32 例患有 44 个非外生型 HCC 病变（22 例为单发病变，8 例为 2 个病变，2 例为 3 个病变）的患者，所有患者均为 Child A 或 B 级，均接受了全面的临床评估、实验室检查和影像学检查。腹腔镜辅助经皮 MWA 是我们研究中所有患者的首选治疗方法，无论是外生型还是非外生型病变，对于外生型病变采用无接触楔形技术，对于非外生型病变采用直接穿刺技术。
两组的技术成功率均为 100%，所有病变均完全消融，LIous 证实。两组均无严重并发症或围手术期死亡，局部肿瘤进展发生率较低。
腹腔镜辅助 MWA 治疗外生型 HCC 是安全有效的，与非外生型 HCC 的结果相当。外生型 HCC 不是 MWA 的禁忌证，只要选择适当的技术。
