Complications and Management of Microwave Coagulation Therapy for Primary and Metastatic Liver Tumors

Abstract

Microwave coagulation therapy (MCT) has been widely used, both percutaneously and directly, as effective minimal invasive therapy for liver tumors. To facilitate the use of MCT, we describe the complications we have encountered, and their possible management and prophylaxis. MCT was performed for 42 patients with hepatocellular carcinoma (HCC) and for 29 with metastatic liver tumors, following which complications developed in 14.2% and 20.6% of the HCC and metastatic groups, respectively. The complications included abscess, biloma, bleeding, hepatic failure, and dissemination of cancer cells. In the HCC group, the mean value of tumor size and the clinical stage of patients with complications were significantly larger (P = 0.006) and higher (P = 0.032), respectively, than those of patients without complications. The incidence of complications increased significantly when the tumor size was more than 4cm (P = 0.008). Abscesses and bleeding were successfully treated using percutaneous drainage and interventional angiography, respectively, but as the other serious complications were not able to be treated effectively once induced, prophylaxis is important to facilitate MCT. Transcatheter cooling of the intrahepatic bile duct during MCT and the administration of an anticancer agent into the abdominal cavity are recommended to prevent biloma and dissemination, respectively. MCT is indicated for tumors less than 4 cm in diameter to reduce the risk of complications. The prophylaxis and treatment of these complications enhance the safety of MCT.

Microwave Ablation of Hepatocellular Carcinoma

“…Major complications include bile duct stenosis, uncontrollable bleeding, liver abscess, colon perforation, skin burn and tumor seeding, etc. [12, 26,52,53,54]. Postoperative death due to liver failure was reported for intraoperative MWA [42], whereas no treatment-related deaths for laparoscopic and percutaneous MWA have been reported to date.…”

Interstitial ablative techniques for hepatic tumours

“…It is usually self-limiting and seldom requires transfusion or laparotomy 114 . However, Curley et al 106 93 reported one instance of acute cholecystitis after radiofrequency ablation; biliary fistula and biloma formation have been described after microwave therapy 104,122 . No biliary complications have been reported after ILP therapy.…”

“…Thermal ablation is a well tolerated procedure, with a reported complication rate of 3-7 per cent in most series of radiofrequency and ILP ablation, and of 11-23 per cent in those describing microwave thermal ablation 118,122 . This difference is probably due to the latter therapy being employed predominantly in patients with cirrhosis.…”

Interventional therapies of unresectable liver metastases

“…The complications such as slight pain, fever, and subcutaneous hematoma (total rate about 20.6%) can be experienced immediately after MCT, and in general, special treatment is unnecessary (Matsukawa et al 1997;Shimada et al 1998). …”