The Role of Ablative Techniques in the Management of Hepatocellular Carcinoma: Indications and Outcomes

Abstract

The management of hepatocellular carcinoma (HCC) remains complex and will continue to rely on the multidisciplinary input of hepatologists, surgeons, radiologists, oncologists and radiotherapists. With the appropriate staging of patients and selection of suitable treatments, the outcomes for HCC are improving. Surgical treatments encompassing both liver resection and orthotopic liver transplantation (OLT) are the definitive curative-intent options. However, patient suitability, as well as organ availability, pose essential limitations. Consequently, non-surgical options, such as ablative techniques, play an increasingly important role, especially in small HCCs, where overall and disease-free survival can be comparable to surgical resection. Ablative techniques are globally recommended in recognised classification systems, showing increasingly promising results. Recent technical refinements, as well as the emerging use of robotic assistance, may expand the treatment paradigm to achieve improved oncological results. At present, in very early stage and early stage unresectable disease, percutaneous thermal ablation is considered the treatment of choice. Owing to their different features, various ablative techniques, including radiofrequency ablation, microwave ablation, cryotherapy ablation and irreversible electroporation, have been shown to confer different comparative advantages and applicability. We herein review the role of available ablative techniques in the current complex multidisciplinary management of HCC, with a main focus on the indications and outcomes, and discuss future perspectives.

A Novel Nomogram to Predict Prognosis in Elderly Early-Stage Hepatocellular Carcinoma Patients After Ablation Therapy

“…In comparison to traditional open surgeries, radiofrequency ablation boasts characteristics like minimally invasive procedures, safety, broad applicability, good patient tolerance, confirmed efficacy, fewer complications, and the ability for repeat treatments. 29 , 30 More significantly, it effectively enhances the quality of life and extends the lifespan of elderly liver cancer patients. Consequently, radiofrequency ablation is considered a more suitable option for curative treatment in elderly patients.…”

Repeat hepatectomy versus thermal ablation therapy for recurrent hepatocellular carcinoma: a systematic review and meta-analysis

“…Similarly, it is imperative to acknowledge that TAT represents a technical modality for tumor ablation utilizing high-temperature physical methods, encompassing radiofrequency and microwave ablation techniques ( 40 ). TAT possesses distinctive advantages and can be performed via percutaneous, laparoscopic, or open surgery approaches ( 41 ).…”

Heterogeneity characterization of hepatocellular carcinoma based on the sensitivity to 5-fluorouracil and development of a prognostic regression model

“…Patients with HBV/HCV infection, cirrhosis of any cause, alcoholism, non-alcoholic steatohepatitis, or family history of HCC are considered high-risk groups for HCC, especially among men aged over 40 years old ( Xie et al, 2023 ). Surgical treatment, including hepatectomy and orthotopic liver transplantation, is widely used for tumor eradication ( Kawaguchi et al, 2016 ), but it is also restricted by the applicability of patients and the availability of organs ( Koza et al, 2023 ). In a clinical practice, more than 60% of HCC cases are diagnosed in the late stage, suggesting possible missed diagnostic opportunity.…”