Combined TACE and MWA for Hepat ocellular Carcinoma in Challenging Liver Segments

Combined TACE and MWA for Hepat ocellular Carcinoma in Challenging Liver Segments

Surgical resection is the standard for the treatment of hepatocellular carcinoma (HCC). For tumors in segments IVa, VII and VIII, surgery is challenging and risky because the tumors are adjacent to or sometimes adhere to the root of hepatic veins and the inferior vena cava. Transcatheter Arterial Chemoembolization (TACE) is an alternative treatment option, but it is a non-radical treatment. Tumor ablation therapy may be more effective but there are limitations in terms of tumor size and proximity to greater vessels or adjacent organs.
This study presents three cases of HCC that is located in the hepatic veins confluent area (segments IVa, VII, VIII) and which is treated with a combination of TACE and laparoscopy-assisted ultrasound-guided microwave ablation (MWA). The course of treatment was uneventful and patients were all discharged within a few days because the treatment is minimally invasive. Post-treatment imaging confirmed complete tumor necrosis and serumα-fetoprotein (AFP) levels decreased to the normal range. Follow-up exams also showed no evidence of recurrence.
In conclusion, for medium-sized (3–5 cm) HCC that is located in the hepatic veins confluent area (segments IVa, VII, VIII), the combined use of TACE followed by MWA is an effective treatment strategy.