Special therapeutic procedures
Liver resections are the chosen procedure for patients who suffer from primary or secondary tumors located in this organ. In certain cases, the extension of the illness in this organ or in others, an inadequate hepatic functional reserve or the presence of general contraindications for surgery, determine the search for alternative procedures.
Among these alternatives, different local treatments on the tumoral process are preferable. Radiofrequency ablative treatment, chemoembolization, radiosurgery or intratumoral injection of liquid agents are the most common options. Radiofrequency or thermal tumor ablation (heat) is a relatively new treatment, as it has been developed in the last 20 years. It is now used for treating unresectable solid liver, lung, breast, kidney, prostate, bone, brain, spleen and adrenal glands tumors, as well as peripheral tumor in the billiard tract. Exceptionally, it is used in the control of multiple benign tumors with high risk of malignization (multiple hepatic adenomas).
In the case of the liver, this technique is frequently indicated for treating hepatocellular carcinoma or primary hepatic tumor, as well as hepatic metastasis regardless of their primary origin. The professionals in our institution are some of the most experienced people in the field and use this technique in different situations: 1) as the only therapeutic option, 2) combined with a surgical extirpative treatment, 3) as a temporary treatment before the final therapy, and 4) associated to neo-adjuvant chemotherapy before another treatment (liver transplant).
It can be performed in closed, open and laparoscopic procedures, although the open one is the most frequent. The open procedure is used when associated to liver resection or if the liver needs to be liberated from anatomic structures adhered in patients that have had previous operations. Finally, the laparoscopic procedure is especially suitable for peripheral injuries in which the risk of bleeding is higher or if the patients, who have not had any operation before, needs a closer exploration of their abdominal cavity or the liver parenchyma.
Nowadays, the size of the injury does not affect radiotherapy. Obviously, the effectiveness is reduced if the diameter of the injury is over 8 cm, even if two or three sessions are taken. On the other hand, it is necessary to locate liver injuries (preferably with ultrasound) in order to proceed with the ablative treatment. Smaller injuries, especially those located in the upper-back right hepatic lobe, are hard to reach due to their closeness to the diaphragm and lung. These tumors require a lot of experience in hepatic puncture.
The number of injuries may condition the number of sessions for this treatment. In primary liver injuries or metastasis with neuroendocrine origin (hypervascular injuries), chemoembolizations are also performed in order to increase local necrosis and improve the results.