Opinion Review
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jun 21, 2020; 26(23): 3118-3125
Published online Jun 21, 2020. doi: 10.3748/wjg.v26.i23.3118
Liver-directed therapies for liver metastases from neuroendocrine neoplasms: Can laser ablation play any role?
Sergio Sartori, Lara Bianchi, Francesca Di Vece, Paola Tombesi
Sergio Sartori, Lara Bianchi, Francesca Di Vece, Paola Tombesi, Department of Internal Medicine, Section of Interventional Ultrasound, St. Anna Hospital, Ferrara 44100, Italy
Author contributions: Sartori S and Tombesi P wrote the paper; Bianchi L and Di Vece F reviewed the literature and collected the data.
Conflict-of-interest statement: All authors declare no conflicts-of-interest related to this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Sergio Sartori, MD, Chief Doctor, Director, Department of Internal Medicine, Section of Interventional Ultrasound, St. Anna Hospital, Via A. Moro 8, Ferrara 44100, Italy. srs@unife.it
Received: January 2, 2020
Peer-review started: January 2, 2020
First decision: March 21, 2020
Revised: June 12, 2020
Accepted: June 16, 2020
Article in press: June 16, 2020
Published online: June 21, 2020
Abstract

Aggressive cytoreduction can prolong survival in patients with unresectable liver metastases (LM) from neuroendocrine neoplasms (NEN), and minimally invasive, liver-directed therapies are gaining increasing interest. Catheter-based treatments are used in disseminated disease, whereas ablation techniques are usually indicated when the number of LM is limited. Although radiofrequency ablation (RFA) is by far the most used ablative technique, the goal of this opinion review is to explore the potential role of laser ablation (LA) in the treatment of LM from NEN. LA uses thinner needles than RFA, and this is an advantage when the tumors are in at-risk locations. Moreover, the multi-fiber technique enables the use of one to four laser fibers at once, and each fiber provides an almost spherical thermal lesion of 12-15 mm in diameter. Such a characteristic enables to tailor the size of each thermal lesion to the size of each tumor, sparing the liver parenchyma more than any other liver-directed therapy, and allowing for repeated treatments with low risk of liver failure. A recent retrospective study reporting the largest series of LM treated with LA documents both safety and effectiveness of LA, that can play a useful role in the multimodality approach to LM from NEN.

Keywords: Neuroendocrine neoplasms, Liver metastases, Liver-directed therapies, Ablation techniques, Laser ablation, Radiofrequency ablation

Core tip: Laser ablation (LA) can be useful in the treatment of liver metastases (LM) from neuroendocrine neoplasms (NEN). The multi-fiber technique enables the use of one to four fibers at once, achieving ablation areas from one to 4-5 cm in diameter, and tailoring the size of each thermal lesion to that of each tumor, sparing the liver parenchyma more than any other liver-directed therapy. A recent retrospective study reporting the largest series of LM treated with LA documents both safety and effectiveness of LA, that can be added to the armory of the multimodality approach to LM from NEN.