THORACOSCOPIC TRANSDIAPHRAGMATIC-MICROWAVE COAGULATION THERAPY FOR A LIVER-TUMOR

Background: Microwave coagulation therapy (MCT) for hepatocellular car cinoma, which induces tumor coagulonecrosis, is now recognized as an e fficient treatment. However, when a tumor is located just below the-to p of the diaphragmatic dome, laparotomical MCT requires a large incisi on, and percutaneous MCT is sometimes impossible. Patients and Methods : The patients were four men and two women. There were four cases of h epatocellular carcinoma and two cases of liver metastasis from colorec tal cancer All tumors were located below the top of the diaphragmatic dome. Thoracoscopic transdiaphragmatic MCT (TTMCT) was performed under general anesthesia using an endotracheal double-lumen tube. Identific ation of the tumor site in the liver was performed using-an ultrasonic probe under thoracoscopic observation. After the diaphragm above the tumor was opened, a needle electrode to transmit micro; waves was inse rted directly into the tumor. Microwave irradiation was repeated to co agulate the entire lesion. After completion of TTMCT, the diaphragm wa s closed thoracoscopically. Results: TTMCT was successfully,administer ed to cancerous lesions in all six patients. The postoperative course was uneventful, and the average postoperative hospitalization period w as 10.5 days. None of the patients has shown-any recurrence during a f ollow-up Period of 4-23 months, Conclusions: TTMCT was performed witho ut any difficulty using the thoracoscopic surgical technique, and its therapeutic outcome was satisfactory; This is effective for tumors loc ated just below the top of the diaphragmatic dome.