Liver Tumour Ablation

Who is Liver Ablation suitable for?​

 

The main indication for liver ablation is primary and secondary (metastatic) liver cancers.

Ablation can be offered when surgery is not possible, or as part of a broader treatment plan recommended by your multidisciplinary cancer team.

Common indications* include:

• Hepatocellular carcinoma (HCC) – the most common primary liver cancer, usually arising in a cirrhotic liver.

• Colorectal liver metastases (CRLM) – bowel cancer that has spread to the liver – typically in an oligometastatic or oligoprogressive setting.

• Neuroendocrine tumour (NET) metastases.

• Other secondary cancers such as breast, melanoma, or thyroid cancer metastases (in selected cases); typically in an oligometastatic or oligoprogressive setting.

Ablation can also be used as a “bridge” treatment before liver transplantation, or to control small recurrent tumours after surgery.

Ablation is usually recommended after discussion at a multidisciplinary tumour board, which includes specialists in radiology, hepatology, surgery, and oncology.

Ablation may not be suitable if:

• A tumour lies very close to the main bile ducts.

• There is uncontrolled bleeding tendency or severe ascites.

• The tumour cannot be safely accessed or treated without risk to vital structures (uncommon with modern techniques).

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Procedure

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1. Consultation:
   You will meet your Interventional Radiologist before the procedure to review your scans, discuss the plan, and answer any questions. At this visit, your imaging, medical history, and medications are checked, and you’ll be guided through what to expect on the day of treatment.
    

2. Preparation:
   Routine blood tests are performed to check your liver function and clotting profile.
   You will be advised if you need to stop certain medications (such as blood thinners) at initial consultation. You will be asked to fast for several hours beforehand.
    

3. Ablation:
   The procedure is performed in a specialised procedure or CT room, typically under general anaesthesia. Following cleaning, draping, and numbing the skin, using ultrasound or CT guidance, the Interventional Radiologist inserts a thin (~3mm) ablation probe (needle) directly into the tumour. Heat (i.e. microwave energy) or cold (cryoablation) is applied for several minutes to destroy both tumour and a small margin. Once complete, the probe is removed and a small dressing is applied — no stitches are required. The procedure usually takes 30–90 minutes, depending on the number and size of tumours treated.
    

4. Post-operative care:
   You will ll be monitored in recovery until fully awake and comfortable, before being admitted overnight to a ward for observation. Many patients experience mild fatigue or shoulder discomfort for a few days, managed with simple pain relief. You can generally return to light activities within a few days and normal routines within one to two weeks. A follow-up CT or MRI scan is arranged at 4–6 weeks post procedure to confirm successful treatment, as well as clinical follow up with your Specialist Interventional Radiologist and Hepatologist.

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Benefits

 

• Minimally invasive: no large incisions, and quicker recovery than surgery. The vast majority of our patients are discharged the next morning.  

• Curative potential: for smaller (≤3cm) liver tumours detected early, ablation has demonstrated outcomes similar to surgery*.

• Repeatable: can be safely repeated for new or recurrent tumours; unique to this treatment method.

• Bridge to transplant: has a role in disease control in patients awaiting liver transplantation.

• Combinable: can be used alongside other treatments such as transarterial chemoembolisation (TACE) or systemic therapy; especially for larger lesions.

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*Meijerink et al; COLLISION trial, 2024

 

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Risks and Side Effects

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Liver ablation is generally safe, but as with any medical procedure complications can and occasionally do occur.

Common minor effects:

• Mild pain or discomfort in the right upper abdomen or shoulder

• Low-grade fever, tiredness, or flu-like symptoms (termed “post-ablation syndrome”) for a few days

Uncommon or rare risks (2–3% overall):

• Bleeding or infection

• Injury to nearby bile ducts or bowel

• Liver abscess

• Temporary changes in liver function tests

Your doctor will discuss your individual risk profile before the procedure.

 

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Outcomes and Results

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Liver ablation provides effective local tumour control with a faster recovery and less invasiveness than open surgery in carefully selected patients.

 

How it compares with surgery:

• For small tumours in suitable locations, ablation can achieve cancer control similar to surgery – but without the need for a major incision.

• Most patients go home after one night in hospital, with sooner return to daily activities.

• Because ablation preserves more healthy liver tissue, it maintains liver function for future treatments if needed.

 

Benefits in oligometastatic, or oligoprogressive disease:

• In oligometastatic colorectal cancer, combining ablation with systemic therapy can control visible liver spots, delay progression, and extend treatment options.

• Ablation can target small deposits that are technically difficult or unsafe to remove surgically.

• It can be repeated and integrated with other therapies (surgery, TACE, SBRT, or systemic therapy) as part of an individualised plan.

• In progressive or symptomatic disease (e.g., some NET metastases), ablation may reduce tumour burden and relieve symptoms.

 

Your exact outcome depends on tumour type, size (lesions ≤3 cm respond best), number and location of lesions, underlying liver health, and overall fitness.
 

Your multidisciplinary team will recommend the best combination and timing of treatments for you.

 

Specialist Expertise

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Interventional Radiologists (IRs) are uniquely specialty trained in both the advanced imaging assessment and grading of liver tumours and image-guided "pin-hole" procedures including biopsy, embolisation and ablation. Interventional Radiologists (IRs) are broadly experienced in ablation procedures as they undergo comprehensive dedicated training in Radiofrequency Ablation (RFA), Cryoablation, and Microwave Ablation (MWA) of tumours throughout the body, including the kidney, liver, lung and thyroid.

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Public eligible patients can typically undergo the treatment with no out-of-pocket expense in the public system. Liver ablation is performed at most of our public and private hospital locations in Melbourne, Victoria, Australia.

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Liver ablation content by Dr James Lisik.