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Editorial

The evolving role of laparoscopic ablation
The evolving role of laparoscopic ablation

Joseph F. Buell

Tulane Transplant Institute, Tulane University, New Orleans, LA 70118, USA

Address for correspondence:
Address for correspondence:
Prof. Joseph F. Buell, Tulane Transplant Institute, Tulane University, New Orleans, LA 70118, USA. E-mail: jbuell1@tulane.edu
Received: 10-06-2015, Accepted: 17-06-2015

In the last two decades, the etiology of hepatocellular cancer Surgical ablation initially was hampered by technologic
has shifted from hepatitis B to hepatitis C with the incidence limitations. This included liver fracture and profuse bleeding
of nonalcoholic steatohepatitis ( NASH) rising dramatically. associated with cryotherapy, and prolonged treatment
This sudden rise in NASH and newly diagnosed cases of times and patient hyperthermia with radiofrequency
hepatocellular cancer may represent the tip of an epidemic. ablation. Radiofrequency ablation with its slow thermal
Current recommendations for patients with chronic hepatitis B evolution was susceptible to heat sink and inadequate
or hepatitis C infections should be screened with routine use ablations. The most recent evolution in ablation was the
of ultrasound. Despite this Surveillance, Epidemiology, and development of microwave ablation. Microwave catheters
End Results, data would suggest that the average size of newly were designed to decrease treatment times and overcome
diagnosed hepatocellular cancer is beyond the Milan criteria thermal sinks.
at the time of diagnosis. In the setting of fatty liver disease
and NASH, an early serologic diagnosis is not evident. Despite the improved treatment capacity, microwave
catheters create more oblong ablation cavities. The treatment
Significant limitations already exist in the availability of liver areas are not exact with potential marginal recurrence from
allografts for liver transplantation. This constraint in organ inadequate ablations. Next generation microwave catheters
availability necessitates improved loco-regional therapies. are being designed to generate uniform ablation defects.
Open and laparoscopic liver resection have been traditionally Alternative treatment options include advanced imaging
limited to Child’s A and early B cirrhotics. In recent registration and catheter placement. In this current issue
years, more sophisticated evaluations have been proposed of Hepatoma Research, the role of laparoscopic ablation is
including transjugular pressure gradients and vital dye discussed and evaluated. Additional articles discuss the
excretion. With the unfortunate limitations in transplantation mechanism and role of sorafenib in the adjuvant and primary
and resection, ablation has become the mainstay of therapy. treatment of unresectable hepatocellular cancer .
Chemoembolization and later radioembolization with yttrium
have been most frequently employed a technique for ablation. In the next decade, the number and incidence of unresectable
and untransplantable liver cancers will increase dramatically.
Access this article online This necessitates improvements in loco-regional control
Quick Response Code including ablation technologies and adjuvant systemic
Website:
therapies.
http://www.hrjournal.net/
How to cite this article: Buell JF. The evolving role of laparoscopic ablation.
Hepatoma Res 2015;1:49.
DOI:
10.4103/2394-5079.159519
Source of Support: Nil. Confl ict of Interest: None declared.

Hepatoma Research | Volume 1 | Issue 2 | July 15, 2015 49