الفهرس 
Acknowledgement
Surveillance for HCCOnly 14 pages are availabe for public view
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Abstract
Management of early HCC in cirrhotic patients is still challenge and hepatic resectionremains the best curative treatment but, reduced liver function due to cirrhosis, the post-operative decompensationand also there is a risk of recurrence of HCC make it less favorablethan the microwave ablation which offer several advantages, including faster heating over a larger volume, less susceptibility to “heat sinks” or local perfusion and the ability to create much larger ablation zones if needed.So, our study was done to evaluate microwave ablation versus hepatic resection in management of hepatocellular carcinoma by assessment of the patient pre intervention and post intervention in short term follow up.
The study was performed in Assiut University Hospital (AL Rajhyhospital) for patient underwent hepatic resection and National Hepatology and Tropical Medicine Research Institute in Cairo for patient underwent microwave ablation.We recruited 40 patients, of which 20 patients from National institute of Tropical medicine & Hepatology in Cairo and the other 20 cases from Assiut University Hospital (EL Rajhy hospital)between 2014 till 2016.All the included patients had histological or radiological proven cases of HCC. with HCC ≤ 5 cm and amenable for microwave ablation or surgical resection. We had been excluded Patients with advanced HCC or with focal lesion not amenable for resection or microwave ablation, Patients who refuse follow up and evaluation, Failure to obtain the informed consent, Pregnantpatients because potential risks to the patient and/or fetus have not been established and patients with implanted electronic devices such as implantable pacemakers that may be adversely affected by microwave power output.
All patients were subjected to detailed medical history and complete clinical examination. Blood samples have been tested for complete blood count, liver function tests, renal profile, international normalization ratio (INR), serum alpha-fetoprotein level. Patients also underwent abdominal ultrasound and triphasic CT examination of the abdomen. Patients with lesions, which were shown an enhancement in the arterial phase and a washout in the venous phase, will be included in this study. Appropriate candidate had been subjected to either microwave or hepatic resection according to a multidisciplinary team that includes a hepatobiliary surgeon, radiologist, hepatologiest and oncologist.Reassessment and follow up after one month of the patients were included by complete clinical examination. Also,blood samples for complete blood count, liver function tests, renal profile, international normalization ratio (INR), serum alpha-fetoprotein level. Abdominal ultrasound and triphasic CT examination of the abdomen to evaluate (WHOperformancestatus, child score, BCLC classification).This study showed that there is highly significant difference between the level of alpha fetoprotein before and after hepatic resection (as the mean level before resection is 172.73 and after liver resection is 10.95). also there this statistically significant difference in the alpha fetoptoprotin level between patient underwent hepatic resection and those underwent microwave ablation as P value (0.035) although that there is no stastically difference before both interventions as P value (0.602). There is decrease in Child’sscore after hepatic resection in comparison to the meanChild’sscorefor patients underwent microwave ablation (beforeablation 6.1± 0.7 and after ablation 6.1± 1.0), But was afterhepaticresection 7.2±1.4 and before resection was 5.5± 0.6).Also we notice that there is decrease in the level of albumin in comparison of its pre resection level and increase the total leukocytes count in spite of this, there is no difference of serum albumin level or leukocytes count after microwave ablation (as the serum albumin was 3.34±0.63 after microwave ablation and 2.83±0.75 after hepatic resection, the mean wight blood count level was 5.16±1.51 after microwave ablation and 12.71±9.03 after hepatic resection). The mean prothrombin concentration decrease post hepatic resection in comparison to its level post microwave ablation as it was 74.79±16.15 after microwave ablation and was 63.7±16.47 after hepatic resection.< The mean time for ablation by microwave was 80.5 second and the mean power was 58 Watt.
Recurrence occur only in (5%) case of recurrence post hepatic resection after one month but no recurrence occur in the same lesion post microwave ablation. Residual activity occurs only in patients underwent microwave ablation (in 10% of cases) but, not occur in patient underwent hepatic resection.Appearance of new lesion occur in (25%) of cases underwent microwave ablationand appearance of new lesion occur in (5%) of cases underwent hepatic resection.Fewer complications were recorded post microwave ablation, as we found that ascites occurs in 20%, plural effusion occur in 15 % and skin laceration 5% of patients underwent microwave ablation.We categories complication post hepatic resection as recurrence occur in 5% (but no residual activity had been detected at all), Appearance of new lesion occur in only in 5% of patients, hepatic encephalopathy in 10% of the patients, plural effusion in 10% of patients and ascites 50% of patients.