Published online Jun 21, 2020. doi: 10.3748/wjg.v26.i23.3118
Peer-review started: January 2, 2020
First decision: March 21, 2020
Revised: June 12, 2020
Accepted: June 16, 2020
Article in press: June 16, 2020
Published online: June 21, 2020
Processing time: 170 Days and 23.1 Hours
Aggressive cytoreduction can prolong survival in patients with unresectable liver metastases (LM) from neuroendocrine neoplasms (NEN), and minimally invasive, liver-directed therapies are gaining increasing interest. Catheter-based treatments are used in disseminated disease, whereas ablation techniques are usually indicated when the number of LM is limited. Although radiofrequency ablation (RFA) is by far the most used ablative technique, the goal of this opinion review is to explore the potential role of laser ablation (LA) in the treatment of LM from NEN. LA uses thinner needles than RFA, and this is an advantage when the tumors are in at-risk locations. Moreover, the multi-fiber technique enables the use of one to four laser fibers at once, and each fiber provides an almost spherical thermal lesion of 12-15 mm in diameter. Such a characteristic enables to tailor the size of each thermal lesion to the size of each tumor, sparing the liver parenchyma more than any other liver-directed therapy, and allowing for repeated treatments with low risk of liver failure. A recent retrospective study reporting the largest series of LM treated with LA documents both safety and effectiveness of LA, that can play a useful role in the multimodality approach to LM from NEN.
Core tip: Laser ablation (LA) can be useful in the treatment of liver metastases (LM) from neuroendocrine neoplasms (NEN). The multi-fiber technique enables the use of one to four fibers at once, achieving ablation areas from one to 4-5 cm in diameter, and tailoring the size of each thermal lesion to that of each tumor, sparing the liver parenchyma more than any other liver-directed therapy. A recent retrospective study reporting the largest series of LM treated with LA documents both safety and effectiveness of LA, that can be added to the armory of the multimodality approach to LM from NEN.