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Should hepatocellular carcinoma be ablated or resected?

Nature Clinical Practice Gastroenterology & Hepatology volume 4, pages 586–587 (2007)Cite this article

The vast majority of patients with hepatocellular carcinoma (HCC) have underlying liver disease. Optimal treatment for these patients is, therefore, liver transplantation, but when this is not possible the question arises as to whether to resect or ablate the cancer. Underlying liver disease restricts the volume of liver that can be resected safely, and increases the morbidity of resection. The inability to resect HCC because of underlying liver disease has stimulated research for new focal ablative techniques. The first ablation technique to gain widespread clinical acceptance was percutaneous ethanol injection (PEI). This procedure involves the insertion of a fine needle into the tumor under ultrasound guidance, followed by the injection of 100% ethanol into the tumor. Radiofrequency ablation (RFA) has, however, largely replaced PEI. RFA involves the percutaneous insertion of an electrode into the tumor under imaging guidance. An alternating current is delivered through the electrode causing ionic agitation, frictional heating and cell death. RFA has become the most widely used ablative technique in clinical practice and has been approved by NICE (the UK National Institute for Health and Clinical Excellence; www.nice.org.uk).There are, however, still some indications for PEI (e.g. in patients with exophytic tumors), which is much cheaper than RFA and is, therefore, still used in developing countries. In the future, microwave ablation might demonstrate significant advantages over RFA.

Compared with resection, ablation has several attractive features. It is a low risk procedure with minimal mortality and limited morbidity. It is cheaper than resection, widely available, readily repeated and does not incur the loss or damage of non-neoplastic parenchyma beyond a 1 cm margin around the tumor. The latter feature is important in patients with HCC in whom two distinct entities—liver disease and malignancy—contribute to their reduced survival. The best indication for ablation is in patients with small tumors. Increased availability of ultrasound screening programs will result in the earlier detection of small tumors that can be successfully ablated.

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  1. Specialist X-ray, Podium 2, UCH, 235 Euston Road, London NW1 2BU, UK a.gillams@medphys.ucl.ac.uk

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  1. AR Gillams is a Senior Lecturer and an Honorary Consultant at the University College Medical School and University College Hospital, London, UK.,

    Alice R Gillams

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  1. Alice R Gillams
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Gillams, A. Should hepatocellular carcinoma be ablated or resected?. Nat Rev Gastroenterol Hepatol 4, 586–587 (2007). https://doi.org/10.1038/ncpgasthep0962

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