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Kawasaki Medical School Kurashiki 701-0192, Japan
We previously reported the successful use of percutaneous microwave coagulation therapy with intraperitoneal saline infusion to treat a small hepatocellular carcinoma on the dome of the liver for cases in which the whole lesion could not be visualized on sonography [1]. After 300-400 mL of saline was infused, the liver was separated from the diaphragm and the tumor, which was located just beneath the diaphragm, became completely visible on sonography. As a result, the tumor could be accurately targeted, facilitating microwave ablation. Patients experienced just a slight sensation of heat, pain, or both during microwave treatment and no skin burns at the insertion site. The intraperitoneal instillation of saline may also help to protect adjacent structures from potential thermal injury. The saline was absorbed without any treatment within a few days after microwave therapy, and there were no severe adverse reactions such as bleeding or seeding of tumor cells.
We have also reported that percutaneous microwave coagulation therapy can be performed safely in patients with cirrhosis and can achieve complete necrosis of superficial hepatocellular carcinomas located on the surface of the liver [2]. In some of these patients, however, cutaneous burns occur at the insertion site and these patients are likely to complain of severe pain.
On the basis of this experience, we performed percutaneous microwave coagulation therapy using artificially created ascites in a patient with a hepatocellular carcinoma that was located near the surface of the liver. A 60-year-old man was admitted to our hospital with a superficial hepatocellular carcinoma in segment V of the liver (Figs. 2A and 2B). Percutaneous microwave coagulation therapy with a hemostatic effect [3] was performed because of poor liver function and his bleeding tendency. After 40-50 mL of a local anesthetic (0.5% lidocaine) was infused to create artificial ascites (Fig. 2C), a microwave electrode was inserted percutaneously into the lesion under sonographic guidance to irradiate the tumor with 60-W microwaves. The site of microwave irradiation did not show any contrast enhancement on enhanced CT images obtained after treatment, suggesting that satisfactory coagulative necrosis had occurred (Fig. 2D). The infused fluid was absorbed without any specific treatment within a few hours after microwave therapy, and the patient had no adverse reactions such as a sensation of heat, pain, or skin burns.
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In conclusion, our experience with this patient suggests that artificial ascites can be created using 40-50 mL of 0.5% lidocaine rather than requiring 300-400 mL of saline, and the infused fluid can prevent burning of the abdominal wall and a sensation of heat, pain, or both during microwave irradiation. Therefore, percutaneous microwave coagulation therapy using the artificial ascites method seems to be a useful and safe treatment especially for cases of superficial hepatocellular carcinoma.
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