Surgical resection remains the gold standard treatment for CLMs,achieving 10-year survival rate of 22% in a selected group of patients. However, only 20% of CLMs are amenable to resection at time of
diagnosis. Despite the increased resectability in advanced CLMs with two-stage hepatectomy, approximately 20% of patients may fail to
go through with the planned treatment. The rate of resectability had also expanded over the years owing to the availability of better
chemotherapy agents permitting improved local disease control and down staging of tumor burden allowing subsequent resection.
Post-operative hepatic functional reserve remains the main limitation to surgical resection, hence the attractive alternative of
employing the adjunctive use of ablative therapies. There are multiple methods of percutaneous imaging-guided ablation. The simplest
of these is alcohol injection but this has a role limited to small hepatocellular carcinoma. Cryotherapy and radiofrequency ablation
will be discussed in detail. The role of these treatments are probably best limited to unresectable tumors or patients who are unfit for
resection because we have been ultimately led to believe that ablation can ensure the long-term survival results of resection. The application
of cryotherapy is not limited to lesion ablations but also may be used to treat suboptimal or involved margins of resection in patients precluded
from extended resections. Long-term data following thermal ablation are scarce. Till date, the superiority of either thermal ablative method
remains unclear and further sizeable comparative studies would be required to determine this.
3.122
diagnosis. Despite the increased resectability in advanced CLMs with two-stage hepatectomy, approximately 20% of patients may fail to
go through with the planned treatment. The rate of resectability had also expanded over the years owing to the availability of better
chemotherapy agents permitting improved local disease control and down staging of tumor burden allowing subsequent resection.
Post-operative hepatic functional reserve remains the main limitation to surgical resection, hence the attractive alternative of
employing the adjunctive use of ablative therapies. There are multiple methods of percutaneous imaging-guided ablation. The simplest
of these is alcohol injection but this has a role limited to small hepatocellular carcinoma. Cryotherapy and radiofrequency ablation
will be discussed in detail. The role of these treatments are probably best limited to unresectable tumors or patients who are unfit for
resection because we have been ultimately led to believe that ablation can ensure the long-term survival results of resection. The application
of cryotherapy is not limited to lesion ablations but also may be used to treat suboptimal or involved margins of resection in patients precluded
from extended resections. Long-term data following thermal ablation are scarce. Till date, the superiority of either thermal ablative method
remains unclear and further sizeable comparative studies would be required to determine this.
Last date updated on September, 2024
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