The Treatment Of Primary And Secondary Hepatic Tumours By Percutaneous Methods

In patients with colorectal carcinoma the presence of liver metastasis is the most accurate predictor of survival. Resection of liver metastases is known to increase the lifespan of patients, with good quality.

of life and an overall 5-year survival of 20–45%, and up to 60% in unifocal disease. Without surgery the 5-year survival in this patient group is effectively zero. However, not all patients with liver metastases are deemed suitable for resection, being poor surgical risks or having lesions which are either too large or affect too many hepatic segments.
Percutaneous ablation of liver tumours is now a viable and rapidly developing option for control of liver metastases, prolonging survival time after initial diagnosis and, in some cases, shrinking tumours to enable future curative resection.
Various methods have been investigated, using ultrasound guidance.

● Alcohol injection has proved highly effective for hepatocellular carcinoma (HCC),
shrinking tumours over a period of time and causing necrosis within them, but has not
proved as effective for metastatic liver disease. This is thought to reflect the fact that HCC is a ‘soft’ tumour and so the alcohol can be instilled effectively into the tumour whereas metastases are ‘hard’ lesions and often the alcohol seeps out of the lesion.
● Radiofrequency (RF) thermal ablation and laser ablation are also developing as minimally invasive percutaneous therapeutic techniques and are becoming increasingly popular.

Ablation of liver metastases using RF is a recent method of ultrasound-guided therapy for liver metastases and HCC in which RF, applied to monopolar electrodes either individually or with multiprobe arrays, is guided into the lesion to be treated. RF tissue ablation through an 18G needle uses fewer probes than laser. It is an outpatient procedure:
Sessions has been reported to achieve complete necrosis of liver metastases in 67% of lesions. It is a simple, safe and potentially effective treatment for liver metastases, associated with a low rate of complications (in one study only one small area of haemorrhage was observed in 75 sessions) together with a significant rate of shrinking or stabilization of the metastases.

Ultrasound Tags: usg