Ablation for liver tumours

Ablation for liver tumours

Ablative therapies destroy tumour by the direct application of energy or toxic substances to discrete lesions. The basic tech - nique for RFA was described in 1891 by d’Arsonval, who first - demonstrated that heat was produced when radiofrequency waves passed through tissue. Ablation techniques now include RFA, micr owave ablation, cryoablation, laser ablation, irre - versible electroporation (IRE) and alcohol injection, all of which can be performed percutaneously , laparoscopically or at open surgery . There is wide variation in ov erall survival and local recurrence rates following ablation and surgery remains the gold standard treatment for resectable disease. Despite - these concerns, ablation still has a role as an adjunct to resec - tion and for combined approaches. Patients with small-volume resectable lesions who are not su ffi ciently fit to undergo liver resection should be considered for ablation, as should those with liver metastases where predicted FLR precludes resection. RF A and microwave ablation, which rely on the generation of heat, are the most widely used techniques. Increasing lesion - size exponentially increases impedance, limiting the size of the e ff ective ablation zone and increasing the risk of local recur - rence. Microwave ablation has been designed to overcome these issues with higher intratumoral temperatures, larger tumour ablation volumes and faster ablation times. Newer microwave tec hnologies include the use of cooled applicators and multiple antennae, such that tumours adjacent to large vascular structures can be e ff ectively treated. Local recurrence after RFA and microwave ablation is 5–15%.