IR Playbook pp 397-403 | Cite as

Liver Ablation

  • Jimmy Ton
  • Edward Kuoy
  • Nadine Abi-JaoudehEmail author


Various hepatic pathologies, including primary hepatocellular carcinoma, metastases, and symptomatic simple cysts, may be treated with liver ablation therapy. There are a variety of ablation devices and techniques such as radiofrequency ablation, microwave ablation, cryoablation, and alcohol ablation. In this chapter, we will discuss the current clinical indications, outcomes, and potential complications of interventional treatment for these hepatic pathologies, with particular emphasis on hepatocellular carcinoma. Alternative therapies, including recent molecular-based therapies, will also be discussed. Finally, a brief guide will be provided for a typical interventional thermal ablation procedure.


Liver ablation Hepatocellular carcinoma Liver cancer Liver metastases Liver cysts Thermal ablation Radiofrequency ablation Microwave ablation Cryoablation Percutaneous ethanol injection Hydrodissection 


  1. 1.
    McGlynn KA, Petrick JL, London WT. Global epidemiology of hepatocellular carcinoma: an emphasis on demographic and regional variability. Clin Liver Dis. 2015;19(2):223–38.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Parkin DM, Bray F, Ferlay J, Pisani P. Estimating the world cancer burden: Globocan 2000. Int J Cancer. 2001;94(2):153–6.CrossRefPubMedGoogle Scholar
  3. 3.
    Ryerson AB, Eheman CR, Altekruse SF, Ward JW, Jemal A, Sherman RL, et al. Annual report to the nation on the status of cancer, 1975–2012, featuring the increasing incidence of liver cancer. Cancer. 2016;122(9):1312–37.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Verslype C, Van Cutsem E, Dicato M, Arber N, Berlin JD, Cunningham D, et al. The management of hepatocellular carcinoma. Current expert opinion and recommendations derived from the 10th World Congress on Gastrointestinal Cancer, Barcelona, 2008. Ann Oncol. 2009;20(Suppl 7):vii1–6.PubMedGoogle Scholar
  5. 5.
    El-Serag HB, Kanwal F. Epidemiology of hepatocellular carcinoma in the United States: where are we? Where do we go? Hepatology. 2014;60(5):1767–75.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    El-Serag HB. Hepatocellular carcinoma. N Engl J Med. 2011;365(12):1118–27.CrossRefPubMedGoogle Scholar
  7. 7.
    Forner A, Llovet JM, Bruix J. Hepatocellular carcinoma. Lancet. 2012;379(9822):1245–55.CrossRefPubMedGoogle Scholar
  8. 8.
    Leung TW, Tang AM, Zee B, Yu SC, Lai PB, Lau WY, et al. Factors predicting response and survival in 149 patients with unresectable hepatocellular carcinoma treated by combination cisplatin, interferon-alpha, doxorubicin and 5-fluorouracil chemotherapy. Cancer. 2002;94(2):421–7.CrossRefPubMedGoogle Scholar
  9. 9.
    Simonetti RG, Liberati A, Angiolini C, Pagliaro L. Treatment of hepatocellular carcinoma: a systematic review of randomized controlled trials. Ann Oncol. 1997;8(2):117–36.CrossRefPubMedGoogle Scholar
  10. 10.
    Zhu AX, Blaszkowsky LS, Ryan DP, Clark JW, Muzikansky A, Horgan K, et al. Phase II study of gemcitabine and oxaliplatin in combination with bevacizumab in patients with advanced hepatocellular carcinoma. J Clin Oncol. 2006;24(12):1898–903.CrossRefPubMedGoogle Scholar
  11. 11.
    Poon RT, Fan ST, Lo CM, Ng IO, Liu CL, Lam CM, et al. Improving survival results after resection of hepatocellular carcinoma: a prospective study of 377 patients over 10 years. Ann Surg. 2001;234(1):63–70.CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Takayama T, Makuuchi M, Hirohashi S, Sakamoto M, Yamamoto J, Shimada K, et al. Early hepatocellular carcinoma as an entity with a high rate of surgical cure. Hepatology. 1998;28(5):1241–6.CrossRefPubMedGoogle Scholar
  13. 13.
    Ni JY, Xu LF, Sun HL, Zhou JX, Chen YT, Luo JH. Percutaneous ablation therapy versus surgical resection in the treatment for early-stage hepatocellular carcinoma: a meta-analysis of 21,494 patients. J Cancer Res Clin Oncol. 2013;139(12):2021–33.CrossRefPubMedGoogle Scholar
  14. 14.
    Hemming AW, Cattral MS, Reed AI, Van Der Werf WJ, Greig PD, Howard RJ. Liver transplantation for hepatocellular carcinoma. Ann Surg. 2001;233(5):652–9.CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Iwatsuki S, Starzl TE, Sheahan DG, Yokoyama I, Demetris AJ, Todo S, et al. Hepatic resection versus transplantation for hepatocellular carcinoma. Ann Surg. 1991;214(3):221–8; discussion 8–9.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Hoffmann AC, Gerken GG. Hepatocellular cancer: new kids on the block. Gastrointest Tumor. 2014;1(4):195–200.CrossRefGoogle Scholar
  17. 17.
    Lencioni R, Llovet JM, Han G, Tak WY, Yang J, Guglielmi A, et al. Sorafenib or placebo plus TACE with doxorubicin-eluting beads for intermediate stage HCC: the SPACE trial. J Hepatol. 2016;64(5):1090–8.CrossRefPubMedGoogle Scholar
  18. 18.
    Llovet JM, Ricci S, Mazzaferro V, Hilgard P, Gane E, Blanc JF, et al. Sorafenib in advanced hepatocellular carcinoma. N Engl J Med. 2008;359(4):378–90.CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Gutierrez JA, Gish RG. Efficacy of combination treatment modalities for intermediate and advanced hepatocellular carcinoma: intra-arterial therapies, sorafenib and novel small molecules. Transl Cancer Res. 2013;2(6):460–71.PubMedPubMedCentralGoogle Scholar
  20. 20.
    Bruix J, Qin S, Merle P, Granito A, Huang YH, Bodoky G, et al. Regorafenib for patients with hepatocellular carcinoma who progressed on sorafenib treatment (RESORCE): a randomised, double-blind, placebo-controlled, phase 3 trial. Lancet. 2017;389(10064):56–66.CrossRefPubMedGoogle Scholar
  21. 21.
    Kudo M. Immune checkpoint blockade in hepatocellular carcinoma: 2017 update. Liver Cancer. 2016;6(1):1–12.CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Trojan J, Waidmann O. Role of regorafenib as second-line therapy and landscape of investigational treatment options in advanced hepatocellular carcinoma. J Hepatocell Carcinoma. 2016;3:31–6.CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Amendolara M, Bucca D, Barbarino C, Romano MF, Marino G, Zucchelli M, et al. Surgical management of symptomatic simple hepatic cysts. G Chir. 2012;33(1–2):17–20.PubMedGoogle Scholar
  24. 24.
    Livraghi T, Solbiati L, Meloni F, Ierace T, Goldberg SN, Gazelle GS. Percutaneous radiofrequency ablation of liver metastases in potential candidates for resection: the “test-of-time approach”. Cancer. 2003;97(12):3027–35.CrossRefPubMedGoogle Scholar
  25. 25.
    Mulier S, Mulier P, Ni Y, Miao Y, Dupas B, Marchal G, et al. Complications of radiofrequency coagulation of liver tumours. Br J Surg. 2002;89(10):1206–22.CrossRefPubMedGoogle Scholar
  26. 26.
    Hoffmann R, Rempp H, Schmidt D, Pereira PL, Claussen CD, Clasen S. Prolonged antibiotic prophylaxis in patients with bilioenteric anastomosis undergoing percutaneous radiofrequency ablation. J Vasc Interv Radiol. 2012;23(4):545–51.CrossRefPubMedGoogle Scholar
  27. 27.
    Curley SA, Izzo F, Ellis LM, Nicolas Vauthey J, Vallone P. Radiofrequency ablation of hepatocellular cancer in 110 patients with cirrhosis. Ann Surg. 2000;232(3):381–91.CrossRefPubMedPubMedCentralGoogle Scholar
  28. 28.
    Zhou Y, Zhao Y, Li B, Xu D, Yin Z, Xie F, et al. Meta-analysis of radiofrequency ablation versus hepatic resection for small hepatocellular carcinoma. BMC Gastroenterol. 2010;10:78.CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    Lee KF, Wong J, Hui JW, Cheung YS, Chong CC, Fong AK, et al. Long-term outcomes of microwave versus radiofrequency ablation for hepatocellular carcinoma by surgical approach: a retrospective comparative study. Asian J Surg. 2017;40(4):301–8. 2016. Epub 2016 Feb 24.CrossRefPubMedGoogle Scholar
  30. 30.
    Poulou LS, Botsa E, Thanou I, Ziakas PD, Thanos L. Percutaneous microwave ablation vs radiofrequency ablation in the treatment of hepatocellular carcinoma. World J Hepatol. 2015;7(8):1054–63.CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
    Kim YS, Rhim H, Paik SS. Radiofrequency ablation of the liver in a rabbit model: creation of artificial ascites to minimize collateral thermal injury to the diaphragm and stomach. J Vasc Interv Radiol. 2006;17(3):541–7.CrossRefPubMedGoogle Scholar
  32. 32.
    Laeseke PF, Sampson LA, Brace CL, Winter TC 3rd, Fine JP, Lee FT Jr. Unintended thermal injuries from radiofrequency ablation: protection with 5% dextrose in water. AJR Am J Roentgenol. 2006;186(5 Suppl):S249–54.CrossRefPubMedGoogle Scholar
  33. 33.
    Laeseke PF, Sampson LA, Winter TC 3rd, Lee FT Jr. Use of dextrose 5% in water instead of saline to protect against inadvertent radiofrequency injuries. AJR Am J Roentgenol. 2005;184(3):1026–7.CrossRefPubMedGoogle Scholar
  34. 34.
    Lee SJ, Choyke LT, Locklin JK, Wood BJ. Use of hydrodissection to prevent nerve and muscular damage during radiofrequency ablation of kidney tumors. J Vasc Interv Radiol. 2006;17(12):1967–9.CrossRefPubMedPubMedCentralGoogle Scholar
  35. 35.
    Yang Y, Wang C, Lu Y, Bai W, An L, Qu J, et al. Outcomes of ultrasound-guided percutaneous argon-helium cryoablation of hepatocellular carcinoma. J Hepatobiliary Pancreat Sci. 2012;19(6):674–84.CrossRefPubMedGoogle Scholar
  36. 36.
    Brunello F, Veltri A, Carucci P, Pagano E, Ciccone G, Moretto P, et al. Radiofrequency ablation versus ethanol injection for early hepatocellular carcinoma: a randomized controlled trial. Scand J Gastroenterol. 2008;43(6):727–35.CrossRefPubMedGoogle Scholar
  37. 37.
    Yang CF, Liang HL, Pan HB, Lin YH, Mok KT, Lo GH, et al. Single-session prolonged alcohol-retention sclerotherapy for large hepatic cysts. AJR Am J Roentgenol. 2006;187(4):940–3.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.University of California Irvine, Department of Radiological SciencesOrangeUSA

Personalised recommendations