Percutaneous Ablation of Hepatocellular Carcinoma

Percutaneous ethanol injection (PEI) is performed under ultrasound guidance, with multiple sessions in the out-patient department or with the “single-session” technique under general anesthesia, according to the size and number of the lesions. In our patients, with Child A (293), B (149), or C (20) cirrhosis and single hepatocellular carcinoma (HCC) lesions of 5 cm or smaller, the 1-, 3-, and 5-year survival rates were 98%, 79%, and 47%, 93%, 63%, and 29%, and 64%, 12%, and 0%, respectively. In our 108 patients with larger HCC, 1-, and 3-year survival rates were 72% and 57% in single, encapsulated tumors, 73% and 42% in single infiltrating or multiple encapsulated tumors, and 46% and 0% in symptomatic or with advanced portal thrombosis tumors. PEI proved to be a safe, effective, repeatable, easy, and low-cost therapy for HCC. Survival after PEI was comparable to that after surgical resection, probably because of the balance between the greater complete ablation rate of surgery compared to the absence of early mortality and liver damage using PEI. On the basis of the PEI rationale, other ablation techniques were proposed using radio frequency, laser, or acetic acid methods, and their initial results are promising.