The role of transplantation is controversial. Today, resection remains the mainstay of treatment for most patients with hepatocellular carcinomas arising in noncirrhotic liver or Child-Pugh A patients with stable cirrhosis. Thus, a detailed histologic documentation independently predicts the groups at risk for recurrence. Cryoablation has recently been used as an alternative to resection. Probes of various sizes are inserted in liver lesions under ultrasound guidance.
Liquid nitrogen is circulated in the probes, and the tumor is destroyed by the freezing process.
An iceball with a frozen margin of 1 cm around the tumor is obtained. Based on experimental data, two freeze-thaw cycles are necessary to achieve complete tumor destruction. Definitive data regarding five-year survival for cryoablation of hepatocellular carcinoma are lacking, and mortality and morbidity are variously reported. In a series reporting an average of four cryoablated lesions per patient, the mortality and morbidity from cryoablation were higher than those reported by most recent series of liver resections. New Approaches New techniques of hepatic artery embolization are currently under investigation at the University of Florida for the treatment of primary unresectable liver cancer.