It goes without saying that the larger the tumor, the more difficult it is to treat, and a tumor larger than 10 cm is considered advanced liver cancer. The approximate volume of a tumor of 3 cm in diameter is about 15 cubic centimeters, if the diameter doubles to 6 cm, then his volume will increase to nearly eight times the original size, about 115 cubic centimeters. Based on the normal liver volume of 1500 cubic centimeters, if the liver tumor is larger than 14 centimeters, then it means that the patient has very little normal liver tissue left, but of course the actual situation depends on the patient’s cirrhosis condition. This is why it is very difficult to surgically remove the liver cancer if it is in advanced stage. Besides the fear of high chance of recurrence after surgery, it means that after resection, the remaining liver tissue is not enough, leading to liver ascites, liver coma, or even liver failure. Similarly, metastases are calculated the same way, except that patients with metastases have no or light cirrhosis. Minimally invasive treatment used to be able to treat only tumors below 3 cm, and could only shy away from advanced stage of liver cancer. However, with the increase of treatment experience, we started to try ablation treatment for large tumors from 2007, firstly, for about 5 cm, we used the American RITA radiofrequency needle ablation, or the domestic forerf needle, which takes a long time to operate, about 3 hours at a time, in several treatments. Then with the US COOL-TIP cluster RF needle, it is possible to complete the minimally invasive treatment of 7 cm size tumor in one time in 3 hours and 10 cm tumor in 6 hours. For tumors larger than 10 cm, targeted resection can also be achieved after fractionated ablative treatment. As far as the current technology is concerned, as long as the residual good liver can be 500 cubic centimeters, there is a great possibility to achieve minimally invasive resection of tumor, or to significantly reduce the tumor compliance, and to prolong the life with a certain quality of life without too much pain to the patient. The commonly used ablation methods for solid tumors are radiofrequency ablation, microwave ablation, argon helium knife treatment and chemical ablation. A 56-year-old patient with advanced hepatocellular carcinoma, female, from Anhui province, was seen in January this year for pain in the liver area, with an AFP of 16.49 ng/ml and an abdominal CT indicating advanced hepatocellular carcinoma. It was a giant hepatocellular carcinoma of the right lobe of the liver, 11 cm in diameter, with a total tumor volume of about 695 cm3, an expected ablation lesion volume of about 900-1100 cm3, and a remaining liver tissue volume of about 400-500 cm3 (at least 30% normal liver tissue is required after surgery, otherwise liver failure will occur after surgery); the tumor puncture biopsy diagnosed primary hepatocellular carcinoma. For this patient with advanced hepatocellular carcinoma, one TACE hepatic artery embolization intervention was first performed to ensure the therapeutic effect, so that the blood supply to the tumor was significantly reduced. After that, a single microwave antenna was used for microwave ablation of the tumor, which was a great physical and psychological test for the patient, and a single ablation of all the lesions might lead to serious impairment of the patient’s liver function. The ablation time for each ablation was about 3 hours, and the interval between each microwave ablation was 2 weeks, with careful preoperative and postoperative liver protection and symptomatic support treatment. After more than two months of treatment, three minimally invasive treatments (one TACE, two WMA) were performed, ablating about 90% of the tumor, and the patient felt weak and had limited financial resources, so he was temporarily discharged home to recuperate for one month. One and a half months later, the patient was hospitalized for the second time for review, and CT showed that about 20% of the residual tumor was still alive in the original tumor. The patient was completely cured and achieved tumor-free survival after spending 150,000 yuan, which was determined to have only 3 months of survival in local and major hospitals. 1. The residual tumor 5.A comprehensive postoperative review showed that the huge tumor was completely ablated and necrotic
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