Treatment OptionsThe treatment of primary and malignant liver tumors depends on the extent of the disease within the liver as well as outside the liver, the overall healt of the liver, and the overall health of the patient. The various options in the treatment of focal liver masses are as follows:
- Resection with radiofrequency ablation (Resection with RFA)
- Radiofrequency ablation alone (RFA alone)
- Microwave Ablation (MA)
- intra-operative Magnetic Resonance Imaging (iMRI)
- Unroofing and marsupialization
- Fenestration and resection
For neoplasms, in the absence of extrahepatic disease, resection with negative pathological margins is the preferred treatment. Major typical or atypical anatomical resections can now be carried out with low morbidity and minimal mortality. Extended resections up to 75% of the liver can be safely performed in patients who have no underlying liver disease.
- Selective Internal Radiation Therapy (SIRT)
- Hepatic artery infusion (port or pump)
- Alcohol ablation
New techniques such as enucleation or ablation are available where parenchymal sparing procedures are needed. In addition, other interventions such as hepatic artery embolization of tumors and, in some cases, portal vein embolization of a lobe or more have allowed preoperative downstaging of some tumors and the "remodeling" of nontumoral hepatic parenchyma in anticipation of major resection. An accurate diagnosis and precise determination of the extent of disease are essential.