Liver resection combined with local ablation: where are the limits?

Background/aims: Partial hepatectomy for liver tumors is potentially curative but unfortunately available only for a limited number of patients. Local tumor destruction by ablation has expanded criteria for treatment and potential cure for patients with liver tumors. This paper gives an overview of the possibilities and limitations of ablation of liver tumors.

Methods: A search of relevant peer-reviewed literature was conducted.

Results: Investigations in the second half of the 18th century paved the way for application of electromagnetic fields in living organisms. Currently, indications for thermoablation are (1) unresectable liver tumors, (2) bridging therapy for a more definitive treatment, (3) debulking of symptomatic hormonally active liver tumors, and (4) patients unfit for major abdominal procedures. Although randomized trials on the use of radiofrequency ablation (RFA) are scarce, the results thus far suggest that the combination of partial liver resection and local ablation offers cure rates in the same order of magnitude as partial liver resection - the 'gold standard' - alone. Additionally, RFA seems to be associated with a lower morbidity and mortality rate as compared to partial liver resection. One of the disadvantages is the reported high incidence of ablation site recurrences of sometimes up to 30%. This is especially related to a larger size of ablated tumors and tumors close to large vessels. Also, RFA is a rather time-consuming procedure. On theoretical grounds, ablation with microwaves is more effective and faster and seems to be associated with a lower incidence of ablation site recurrences.

Conclusions: Ablation has acquired a place in the arsenal of treatment modalities for patients with liver tumors and expanded the indications for treatment with a curative intent. Further evolution of the technique and the proof that it has at least the same oncological result with a lower morbidity as partial hepatectomy are required in the near future.