General Considerations for Pre- And Postprocedure Management of Patients Undergoing Liver Tumor Ablation
All patients considered for image-guided therapy of their hepatic tumors should undergo high-quality CT or MRI studies. These allow determination of the number and size of lesions, evidence of extrahepatic spread, and the tumor's relationship to surrounding normal structures such as blood vessels, bile ducts, gallbladder, diaphragm, and bowel. In addition, these exams allow the operator to plan the optimal approach for the subsequent ablation. Patients also should have histological confirmation of hepatic malignancy. Patients with potentially resectable tumors should be sent for surgical evaluation to assess their operative candidacy. Laboratory studies and additional imaging exams should be considered when indicated to exclude distant metastases elsewhere, such as to bone or lungs. In addition, hematological studies should include a complete blood count, international normalized ratio (INR) or prothrombin time (PT) and partial thromboplastin time (PTT), and a platelet count. Abnormal clotting indicators should be corrected prior to an ablation session. Additional laboratory studies should include serum chemistry panel with liver function tests and appropriate tumor markers such as alpha-fetoprotein and carcinoembryonic antigen (CEA).
In the acute postprocedure period, pain and nausea are the two most likely effects of image-guided ablation. Administration of an intravenous antiemetic and analgesic agents immediately postablation may be necessary, but subsequent symptoms usually can be controlled with oral medication. Fever up to 102°F may occur as part of a postablation/postembolization syndrome but generally subsides within 5 days. With any of the ablation techniques, liver abscess is a rare but potentially life-threatening complication. The prophylactic role of antibiotics prior to tumor ablation is controversial.
Follow-up of tumors treated with minimally invasive therapy varies by institution. Our current protocol is to perform immediate CT followed by additional scans every 3 months to evaluate for local recurrence, remote intrahepatic recurrence, and extrahepatic disease. The most common sites of extrahepatic spread of HCC include the lung, abdominal lymph nodes, and bone.[54] With the exception of chemoembolization, the appearance of a successfully treated lesion on follow-up CT is that of a well-defined, low-attenuation, nonenhancing lesion. Variable amounts of reactive hyperemia may be present around the edge of ablated tumors for a month or so after the procedure. Because recurrence of HCC may be evident only during the arterial phase of contrast enhancement on CT or MRI, we routinely perform two-phase (arterial and portal venous phases) CT scans and dynamic contrast-enhanced MRI in these patients. In addition to imaging studies, alpha-fetoprotein and CEA levels should be obtained every 3 months in patients with HCC and colorectal hepatic metastases, respectively. Although every 3-month follow-up of these patients may seem rigorous, the goal of follow-up is the early detection of intrahepatic tumor recurrence, which will allow retreatment at the earliest possible time. As long as sufficient viable hepatic tissue remains, there is no accepted upper limit for how often tumor recurrence may be reablated. However, if extrahepatic spread occurs or extensive intrahepatic tumor develops, systemic therapy may be preferable. Chemoembolization may be preferred over other ablative techniques for extensive intrahepatic disease recurrence.
Semin Liver Dis. 2001;21(2) © 2001 Thieme Medical Publishers
Cite this: Minimally Invasive Techniques for the Treatment of Liver Tumors - Medscape - May 01, 2001.
