Minimally invasive techniques for the treatment of liver tumors

Recently, several minimally invasive, image-guided therapies have been developed for the local treatment of hepatocellular carcinoma (HCC) and hepatic metastases in patients who are considered poor candidates for surgical resection. Radio-frequency ablation, microwave ablation, and laser ablation all destroy tumor by creating a hyperthermic injury. Cryoablation and ethanol ablation achieve cellular death through freezing and direct toxicity, respectively. Chemoembolization is unique in that the entire liver can be treated over time with a combination of cytotoxic drugs and embolic agents, potentially reducing the rate of recurrence from radiologically occult tumor. Outcomes for minimally invasive therapy have approached the success rate of surgical resection in some series with considerably fewer complications. However, a paucity of randomized trials and variability in reporting limit assessment of the relative role of these techniques in clinical practice. With a few exceptions, the indications, contraindications, and complications associated with the different techniques are similar, and success with HCC has exceeded that for metastatic disease independent of technique.