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World J Gastroenterol. Apr 21, 2016; 22(15): 3885-3891
Published online Apr 21, 2016. doi: 10.3748/wjg.v22.i15.3885
Advances in local ablation of malignant liver lesions
Robert M Eisele
Robert M Eisele, Department of General, Visceral, Vascular and Pediatric Surgery, Medical Faculty of the University of Saarland, 66421 Homburg, Germany
Author contributions: Eisele RM solely contributed to this paper.
Conflict-of-interest statement: There are no conflicts of interest to declare.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Robert M Eisele, MD, Department of General, Visceral, Vascular and Pediatric Surgery, Medical Faculty of the University of Saarland, Kirrberger Str. 100, 66421 Homburg, Germany. robert.eisele@uks.eu
Telephone: +49-6841-1631080 Fax: +49-6841-1631002
Received: December 24, 2015
Peer-review started: December 24, 2015
First decision: January 28, 2016
Revised: February 23, 2016
Accepted: March 14, 2016
Article in press: March 14, 2016
Published online: April 21, 2016
Processing time: 101 Days and 16.7 Hours
Abstract

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.

Keywords: Local ablation; Liver; Microwave ablation; Hepatocellular carcinoma; Colorectal liver metastases; Navigation

Core tip: A wide variety of technical innovations enables us to use microwave as well as radiofrequency ablation, various image fusion technologies, magnetic resonance guidance for local ablation, navigation, robotics, and minimal invasive access to liver surgery in general in the 21st century. However, in comparison to data found in the current literature for conventional local ablative treatment strategies, virtually no single technology is able to demonstrate an unequivocal superiority. Most techniques appear technically feasible, albeit demanding. Which technology will in the long run become accepted, is subject to future work.