Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on sleep in brain health

LIVE: Thursday 2nd May 2024, 18:00-19:30 (CEST)

Quality sleep is essential for health. But what happens to our brains when sleep patterns are disturbed? Join our experts to explore the interplay between sleep disruption and neurological diseases, and the questions that you need to be asking your patients to help you prevent the harmful effects of sleep deprivation.
ADVANCED SEARCH
Log in
Top
European Surgery
Published in: European Surgery 3/2018

Open Access 01-06-2018 | main topic

Integrating interventional oncology in the treatment of liver tumors

Authors: D. Putzer, P. Schullian, E. Braunwarth, M. Fodor, F. Primavesi, B. Cardini, T. Resch, R. Oberhuber, M. Maglione, C. Margreiter, S. Schneeberger, S. Stättner, D. Öfner-Velano, W. Jaschke, Prof. Dr. R. J. Bale

Published in: European Surgery | Issue 3/2018

Login to get access

Summary

Background

Percutaneous ablation techniques offer a vast armamentarium for local, minimally invasive treatment of liver tumors, nowadays representing an established therapeutic option, which is integrated in treatment algorithms, especially for non-resectable liver tumors. The results of ablative treatment compare very well to surgical treatment in liver lesions, and confirm that these techniques are a valuable option for bridging for transplantation. Different techniques have been established to perform tumor ablation, and the feasibility varies according to the procedure and technical skills of the operator, depending on the size and location of the liver lesion. In recent years, stereotactic multi-needle techniques using 3D trajectory planning, general anesthesia, and tube disconnection during needle placement have had a strong impact on the application range of ablation for liver tumors.

Conclusion

It is well known that creating a sufficient ablation margin and overlapping ablation zones is one key issue to enable ablation of large liver lesions with tumor-free margins (A0 ablation in analogy to R0 resection). Image fusion during treatment and follow-up assure highly accurate staging procedures and interventional planning.

Novel aspects

Review on the standards in ablation techniques for the treatment of liver tumors. Update on different ablation techniques, indications, and contraindications for percutaneous liver tumor treatment. Summary of recently published reports on liver tumor ablation.
Literature
1.
Abdelaziz A, Elbaz T, Shousha HI, et al. Efficacy and survival analysis of percutaneous radiofrequency versus microwave ablation for hepatocellular carcinoma: an Egyptian multidisciplinary clinic experience. Surg Endosc. 2014;28:3429–34.CrossRefPubMed
2.
Abdelaziz AO, Nabeel MM, Elbaz TM, et al. Microwave ablation versus transarterial chemoembolization in large hepatocellular carcinoma: prospective analysis. Scand J Gastroenterol. 2015;50:479–84.CrossRefPubMed
3.
Bale R, Widmann G. Navigated CT-guided interventions. Minim Invasive Ther Allied Technol. 2007;16(4):196–204.CrossRefPubMed
4.
Bale R, Widmann G, Haidu M. Stereotactic radiofrequency ablation. Cardiovasc Intervent Radiol. 2010;34(4):852–6.CrossRefPubMed
5.
Bale R, Widmann G, Stoffner DI. Stereotaxy: breaking the limits of current radiofrequency ablation techniques. Eur J Radiol. 2010;75(1):32–6.CrossRefPubMed
6.
Bale R, Widmann G, Schullian P, et al. Percutaneous stereotactic radiofrequency ablation of colorectal liver metastases. Eur Radiol. 2012;22(4):930–7.CrossRefPubMed
7.
8.
9.
Bruix J, Takayama T, Mazzaferro V, et al. Adjuvant sorafenib for hepatocellular carcinoma after resection or ablation (STORM): a phase 3, randomised, double-blind, placebo-controlled trial. Lancet Oncol. 2015;16:1344–54.CrossRefPubMed
10.
Brunello F, Veltri A, Carucci P, et al. Radiofrequency ablation versus ethanol injection for early hepatocellular carcinoma: a randomized controlled trial. Scand J Gastroenterol. 2008;43:727–35.CrossRefPubMed
11.
Cha CH, Ruo L, Fong Y, et al. Resection of hepatocellular carcinoma in patients otherwise eligible for transplantation. Ann Surg. 2003;238(3):315–21. discussion 21–3.PubMedPubMedCentral
12.
Chen MS, Li JQ, Zheng Y, et al. A prospective randomized trial comparing percutaneous local ablative therapy and partial hepatectomy for small hepatocellular carcinoma. Ann Surg. 2006;243(3):321–8.CrossRefPubMedPubMedCentral
13.
Cho YK, Kim JK, Kim WT, et al. Hepatic resection versus radiofrequency ablation for very early stage hepatocellular carcinoma: a Markov model analysis. Hepatology. 2010;51:1284–90.CrossRefPubMed
14.
Cucchetti A, Piscaglia F, Cescon M, et al. Cost-effectiveness of hepatic resection versus percutaneous radiofrequency ablation for early hepatocellular carcinoma. J Hepatol. 2013;59:300–7.CrossRefPubMed
15.
Dollinger M, Beyer LP, Haimerl M, et al. Adverse effects of irreversible electroporation of malignant liver tumors under CT fluoroscopic guidance: a single-center experience. Diagn Interv Radiol. 2015;21:471–5.CrossRefPubMedPubMedCentral
16.
Feng K, Yan J, Li X, et al. A randomized controlled trial of radiofrequency ablation and surgical resection in the treatment of small hepatocellular carcinoma. J Hepatol. 2012;57:794–802.CrossRefPubMed
17.
Györi GP, Felsenreich DM, Silberhumer GR, et al. Multimodality locoregional treatment strategies for bridging HCC patients before liver transplantation. Eur Surg. 2017;49(5):236–43.CrossRefPubMedPubMedCentral
18.
Haidu M, Dobrozemsky G, Schullian P, et al. Stereotactic radiofrequency ablation of unresectable intrahepatic cholangiocarcinomas: a retrospective study. Cardiovasc Intervent Radiol. 2011;35(5):1074–82.CrossRefPubMed
19.
Hasegawa T, Yamakado K, Nakatsuka A, et al. Unresectable adrenal metastases: clinical outcomes of radiofrequency ablation. Radiology. 2015;277:584–93.CrossRefPubMed
20.
Heimbach J, Kulik LM, Finn R, et al. AASLD Guidelines for the treatment of hepatocellular carcinoma. Hepatology. 2018;67(1):358–80.CrossRefPubMed
21.
Hocquelet A, Trillaud H, Frulio N, et al. Three-dimensional measurement of hepatocellular carcinoma ablation zones and margins for predicting local tumor progression. J Vasc Interv Radiol. 2016;27:1038–1045.e2.CrossRefPubMed
22.
Hua YQ, Wang P, Zhu XY, et al. Radiofrequency ablation for hepatic oligometastatic pancreatic cancer: an analysis of safety and efficacy. Pancreatology. 2017;17(6):967–73.CrossRefPubMed
23.
Huang YZ, Zhou SC, Zhou H, et al. Radiofrequency ablation versus cryosurgery ablation for hepatocellular carcinoma: a meta-analysis. Hepatogastroenterology. 2013;60:1131–5.PubMed
24.
Hung HH, Chiou YY, Hsia CY, et al. Survival rates are comparable after radiofrequency ablation or surgery in patients with small hepatocellular carcinomas. Clin Gastroenterol Hepatol. 2011;9:79–86.CrossRefPubMed
25.
Kasugai H, Osaki Y, Oka H, et al. Severe complications of radiofrequency ablation therapy for hepatocellular carcinoma: an analysis of 3,891 ablations in 2,614 patients. Oncology. 2007;72:72–5.CrossRefPubMed
26.
Kettenbach J, Wolf F, Wegner M, et al. Percutaneous radiofrequency ablation of liver metastases: applications and potential indications. Eur Surg. 2002;34:326.CrossRef
27.
Kim JH, Won HJ, Shin YM, et al. Radiofrequency ablation for the treatment of primary intrahepatic cholangiocarcinoma. AJR Am J Roentgenol. 2011;196(2):205–9.CrossRef
28.
Kim JH, Won HJ, Shin YM, et al. Medium sized (3.1–5.0 cm) hepatocellular carcinoma: transarterial chemoembolization plus radiofrequency ablation versus radiofrequency ablation alone. Ann Surg Oncol. 2011;18:1624–9.CrossRefPubMed
29.
30.
Lam VW, Ng KK, Chok KS, et al. Incomplete ablation after radiofrequency ablation of hepatocellular carcinoma: analysis of risk factors and prognostic factors. Ann Surg Oncol. 2008;15:782–90.CrossRefPubMed
31.
Lee YH, Hsu CY, Chu CW, et al. Radiofrequency ablation is better than surgical resection in patients with hepatocellular carcinoma within the Milan criteria and preserved liver function: a retrospective study using propensity score analyses. J Clin Gastroenterol. 2015;49:242–9.CrossRefPubMed
32.
Lencioni RA, Allgaier HP, Cioni D, et al. Small hepatocellular carcinoma in cirrhosis: randomized comparison of radiofrequency thermal ablation versus percutaneous ethanol injection. Radiology. 2003;228:235–40.CrossRefPubMed
33.
Li X, Wang J, Li W, et al. Percutaneous CT-guided radiofrequency ablation for unresectable hepatocellular carcinoma pulmonary metastases. Int J Hyperthermia. 2012;28:721–8.CrossRefPubMed
34.
Lin CC, Cheng YT, Chen MW, Lin SM. The effectiveness of multiple electrode radiofrequency ablation in patients with hepatocellular carcinoma with lesions more than 3 cm in size and barcelona clinic liver cancer stage A to B2. Liver Cancer. 2016;5:8–20.CrossRefPubMed
35.
Lin SM, Lin CJ, Lin CC, et al. Radiofrequency ablation improves prognosis compared with ethanol injection for hepatocellular carcinoma < or =4 cm. Gastroenterology. 2004;127:1714–23.CrossRefPubMed
36.
Lin SM, Lin CJ, Lin CC, et al. Randomised controlled trial comparing percutaneous radiofrequency thermal ablation, percutaneous ethanol injection, and percutaneous acetic acid injection to treat hepatocellular carcinoma of 3 cm or less. Gut. 2005;54:1151–6.CrossRefPubMedPubMedCentral
37.
Liu Y, Zheng Y, Li S, et al. Percutaneous microwave ablation of larger hepatocellular carcinoma. Clin Radiol. 2013;68:21–6.CrossRefPubMed
38.
Livraghi T, Solbiati L, Meloni MF, et al. Treatment of focal liver tumors with percutaneous radio-frequency ablation: complications encountered in a multicenter study. Radiology. 2003;226(2):441–51.CrossRefPubMed
39.
Livraghi T, Solbiati L, Meloni F, et al. Percutaneous radiofrequency ablation of liver metastases in potential candidates for resection: the “test-of-time approach”. Cancer. 2003;97(12):3027–35.CrossRefPubMed
40.
Livraghi T, Meloni F, Di Stasi, et al. Sustained complete response and complications rates after radiofrequency ablation of very early hepatocellular carcinoma in cirrhosis: Is resection still the treatment of choice? Hepatology. 2008;47:82–9.CrossRefPubMed
41.
Lu DS, Yu NC, Raman SS, et al. Radiofrequency ablation of hepatocellular carcinoma: treatment success as defined by histologic examination of the explanted liver. Radiology. 2005;234:954–60.CrossRefPubMed
42.
Machi J, Bueno RS, Wong LL. Long-term follow-up outcome of patients undergoing radiofrequency ablation for unresectable hepatocellular carcinoma. World J Surg. 2005;29(11):1364–73.CrossRefPubMed
43.
Mala T, Edwin B, Samset E. Magnetic resonance guided percutaneous cryoablation of hepatic tumors. Eur J Surg. 2001;167:610–7.CrossRefPubMed
44.
Mazzaferro V, Battiston C, Perrone S, et al. Radiofrequency ablation of small hepatocellular carcinoma in cirrhotic patients awaiting liver transplantation: a prospective study. Ann Surg. 2004;240:900–9.CrossRefPubMedPubMedCentral
45.
Mohan H, Nicholson P, Winter DC, et al. Radiofrequency ablation for neuroendocrine liver metastases: a systematic review. J Vasc Interv Radiol. 2015;26(7):935–42.CrossRefPubMed
46.
Mulier S, Mulier P, Ni Y, et al. Complications of radiofrequency coagulation of liver tumours. Br J Surg. 2002;89(10):1206–22.CrossRefPubMed
47.
Nakazawa T, Kokubu S, Shibuya A, et al. Radiofrequency ablation of hepatocellular carcinoma: correlation between local tumor progression after ablation and ablative margin. AJR Am J Roentgenol. 2007;188:480–8.CrossRefPubMed
48.
49.
Ng KK, Fan ST. Current status of radiofrequency ablation for hepatocellular carcinoma. Eur Surg. 2004;36(5):322–30.CrossRef
50.
N’Kontchou G, Mahamoudi A, Aout M, et al. Radiofrequency ablation of hepatocellular carcinoma: long-term results and prognostic factors in 235 Western patients with cirrhosis. Hepatology. 2009;50:1475–83.CrossRefPubMed
51.
Nobuoka D, Motomura Y, Shirakawa H, et al. Radiofrequency ablation for hepatocellular carcinoma induces glypican-3 peptide-specific cytotoxic T lymphocytes. Int J Oncol. 2012;40(1):63–70.PubMed
52.
Ohmoto K, Yoshioka N, Tomiyama Y, et al. Comparison of therapeutic effects between radiofrequency ablation and percutaneous microwave coagulation therapy for small hepatocellular carcinomas. J Gastroenterol Hepatol. 2009;24:223–7.CrossRefPubMed
53.
Oshowo A, Gillams AR, Lees WR, Taylor I. Radiofrequency ablation extends the scope of surgery in colorectal liver metastases. Eur J Surg Oncol. 2003;29(3):244–7.CrossRefPubMed
54.
Pan T, Xie QK, Lv N, et al. Percutaneous CT-guided radiofrequency ablation for lymph node oligometastases from hepatocellular carcinoma: a propensity score-matching analysis. Radiology. 2017;282:259–70.CrossRefPubMed
55.
Pearson AS, Izzo F, Fleming RY, et al. Intraoperative radiofrequency ablation or cryoablation for hepatic malignancies. Am J Surg. 1999;178:592–9.CrossRefPubMed
56.
Peng ZW, Lin XJ, Zhang YJ, et al. Radiofrequency ablation versus hepatic resection for the treatment of hepatocellular carcinomas 2 cm or smaller: a retrospective comparative study. Radiology. 2012;262:1022–33.CrossRefPubMed
57.
Pompili M, Saviano A, de Matthaeis N, et al. Long-term effectiveness of resection and radiofrequency ablation for single hepatocellular carcinoma ≤3 cm. Results of a multicenter Italian survey. J Hepatol. 2013;59:89–97.CrossRefPubMed
58.
Poon RT, Lau C, Pang R, et al. High serum vascular endothelial growth factor levels predict poor prognosis after radiofrequency ablation of hepatocellular carcinoma: importance of tumor biomarker in ablative therapies. Ann Surg Oncol. 2007;14:1835–45.CrossRefPubMed
59.
Ramsey DE, Kernagis LY, Soulen MC, Geschwind JF. Chemoembolization of hepatocellular carcinoma. J Vasc Interv Radiol. 2002;13(9 Pt 2):S211–S21.CrossRefPubMed
60.
Rossi S, Ravetta V, Rosa L, et al. Repeated radiofrequency ablation for management of patients with cirrhosis with small hepatocellular carcinomas: a long-term cohort study. Hepatology. 2011;53:136–47.CrossRefPubMed
61.
62.
Sala M, Llovet JM, Vilana R, et al. Initial response to percutaneous ablation predicts survival in patients with hepatocellular carcinoma. Hepatology. 2004;40:1352–60.CrossRefPubMed
63.
64.
65.
Shibata T, Iimuro Y, Yamamoto Y, et al. Small hepatocellular carcinoma: comparison of radio-frequency ablation and percutaneous microwave coagulation therapy. Radiology. 2002;223:331–7.CrossRefPubMed
66.
Shiina S, Teratani T, Obi S, et al. A randomized controlled trial of radiofrequency ablation with ethanol injection for small hepatocellular carcinoma. Gastroenterology. 2005;129:122–30.CrossRefPubMed
67.
Vogl TJ, Naguib NN, Nour-Eldin NE, et al. Review on transarterial chemoembolization in hepatocellular carcinoma: palliative, combined, neoadjuvant, bridging, and symptomatic indications. Eur J Radiol. 2009;72(3):505–16.CrossRefPubMed
68.
Wang W, Shi J, Xie WF. Transarterial chemoembolization in combination with percutaneous ablation therapy in unresectable hepatocellular carcinoma: a meta-analysis. Liver Int. 2010;30:741–9.CrossRefPubMed
69.
Widmann G, Schullian P, Bale R. Radiofrequenzablation des hepatozellulären Karzinoms. Wien Med Wochenschr. 2013;163:132–6.CrossRefPubMed
70.
Xu HX, Lu MD, Xie XY, et al. Prognostic factors for long-term outcome after percutaneous thermal ablation for hepatocellular carcinoma: a survival analysis of 137 consecutive patients. Clin Radiol. 2005;60(9):1018–25.CrossRefPubMed
71.
Ziol M, Sutton A, Calderaro J, et al. ESM-1 expression in stromal cells is predictive of recurrence after radiofrequency ablation in early hepatocellular carcinoma. J Hepatol. 2013;59:1264–70.CrossRefPubMed
Metadata
Title
Integrating interventional oncology in the treatment of liver tumors
Authors
D. Putzer
P. Schullian
E. Braunwarth
M. Fodor
F. Primavesi
B. Cardini
T. Resch
R. Oberhuber
M. Maglione
C. Margreiter
S. Schneeberger
S. Stättner
D. Öfner-Velano
W. Jaschke
Prof. Dr. R. J. Bale
Publication date
01-06-2018
Publisher
Springer Vienna
Published in
European Surgery / Issue 3/2018
Print ISSN: 1682-8631
Electronic ISSN: 1682-4016
DOI
https://doi.org/10.1007/s10353-018-0521-5

Other articles of this Issue 3/2018

European Surgery 3/2018 Go to the issue

main topic

Indications for liver surgery in benign tumours

main topic

Surgical techniques and strategies for the treatment of primary liver tumours: hepatocellular and cholangiocellular carcinoma

main topic

Optimal perioperative care in peri-hilar cholangiocarcinoma resection

main topic

Liver resection for non-colorectal metastases

editorial

Contemporary liver surgery

main topic

Shaping the future of liver surgery