Laser ablation for small hepatocellular carcinoma: State of the art and future perspectives

Abstract

During the last two decades, various local thermal ablative techniques for the treatment of unresectable hepatocellular carcinoma (HCC) have been developed. According to internationally endorsed guidelines, percutaneous thermal ablation is the mainstay of treatment in patients with small HCC who are not candidates for surgical resection or transplantation. Laser ablation (LA) represents one of currently available loco-ablative techniques. In this article, the general principles, technique, image guidance, and patient selection are reported. Primary effectiveness, long-term outcome, and complications are also discussed. A review of published data suggests that LA is equivalent to the more popular and widespread radiofrequency ablation in both local tumor control and long-term outcome in the percutaneous treatment of early HCC. In addition, the LA technique using multiple thin laser fibres allows improved ablative effectiveness in HCCs greater than 3 cm. Reference centres should be equipped with all the available techniques so as to be able to use the best and the most suitable procedure for each type of lesion for each patient.

Keywords: Liver, Hepatocellular carcinoma, Minimally invasive procedures, Laser, Laser ablation

Core tip: The aim of this review is to describe the basic principles, results in terms of safety and efficacy, and recent advancements in laser ablation (LA). This mini-invasive technique is a less known and few employed procedure as compared to radiofrequency ablation (RFA). However, according to published studies LA is as safe and effective as RFA. In the review the technique and potential advantages of LA are described. Our ambition is to provide the hepatologists, and other physicians, with an updated approach to this ablative technique.