Advances in local ablation of malignant liver lesions.
Local ablation of liver tumors matured during the recent years and is now proven to be an effective tool in the treatment of malignant liver lesions. Advances focus on the improvement of local tumor control by technical innovations, individual selection of imaging modalities, more accurate needle placement and the free choice of access to the liver. Considering data found in the current literature for conventional local ablative treatment strategies, virtually no single technology is able to demonstrate an unequivocal superiority. Hints at better performance of microwave compared to radiofrequency ablation regarding local tumor control, duration of the procedure and potentially achievable larger size of ablation areas favour the comparably more recent treatment modality; image fusion enables more patients to undergo ultrasound guided local ablation; magnetic resonance guidance may improve primary success rates in selected patients; navigation and robotics accelerate the needle placement and reduces deviation of needle positions; laparoscopic thermoablation results in larger ablation areas and therefore hypothetically better local tumor control under acceptable complication rates, but seems to be limited to patients with no, mild or moderate adhesions following earlier surgical procedures. Apart from that, most techniques appear technically feasible, albeit demanding. Which technology will in the long run become accepted, is subject to future work.
Robert M Eisele, Department of General, Visceral, Vascular and Pediatric Surgery, Medical Faculty of the University of Saarland, 66421 Homburg, Germany.
Robert M
RM
Eisele
D055011:Ablation Techniques / Q000009:adverse effects / Q000639:trends*; D003952:Diagnostic Imaging / Q000639:trends; D004059:Diffusion of Innovation; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000639:trends*; D008113:Liver Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology; D065287:Robotic Surgical Procedures / Q000009:adverse effects / Q000639:trends*; D016896:Treatment Outcome
Colorectal liver metastases; Hepatocellular carcinoma; Liver; Local ablation; Microwave ablation; Navigation