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Ablation in Primary Liver Tumors

Minimal invasive thermal ablation techniques have a key role in the treatment regimen of primary liver tumors. These relatively low-risk procedures are established in nonresectable liver tumors and even challenge the surgical approach, which is regarded as first-line treatment in eligible patients.The location and size of the liver tumor, the applied ablation, and guidance technique are crucial for treatment outcome. The confirmation of an adequate ablation zone including sufficient tumor overlap and a safety margin (A0 ablation analogous to R0 resection) is crucial to minimize local recurrence rates and improve survival. A variety of different ablation devices is available. The outcome of conventional computed tomography- or ultrasound-guided thermal ablation in small lesions is well comparable to surgery. However, in liver lesions with large diameter overlapping ablation zones are required to ensure an adequate ablation margin. Therefore, stereotactic techniques in combination with a multiple needle approach, three-dimensional trajectory planning, and image fusion for intraoperative treatment evaluation have been successfully introduced.