[A case report of advanced hepatocellular carcinoma successfully treated with surgical multi-ablation therapy based...

We report a patient with advanced hepatocellular carcinoma (HCC) who was successfully treated with multi-ablation therapy by the surgical method of laparotomy and partial thoracotomy. A 67-year-old man, who had undergone transcatheter arterial embolization (TAE) three times for advanced HCC with hepatitis C, presented at our hospital in May 2001. Although TAE had been performed 3 times starting 2 years earlier, interventional therapy for recurrent tumors is difficult because of stenosis and obstruction of regional hepatic arteries. Computed tomography of the liver revealed five tumors in both lobes and the tumor in segment VIII presented difficulty for percutaneous ablation treatment due to its closeness to the trunk of the hepatic vein. Multi-ablation therapy consisting of radio-frequency ablation, microwave ablation and ethanol injection was selected for this patient. By laparotomy and partial thoracotomy, we performed multi-ablation therapy safely and accurately for each tumor. After this treatment, 5 tumors in both lobes showed no viability on dynamic CT and the patency of the right hepatic vein was preserved. Six months after the treatment, one remnant mass appeared in segment V. An additional two sessions of percutaneous RFA were performed for this tumor. At the end of these treatments, enhanced CT revealed no viability of the tumors, and serum alpha-fetoprotein and PIVKA-II level dropped to the normal range. This case suggests that multiple ablation therapy with a surgical method is feasible and useful in cases of advanced hepatocellular carcinoma.