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Title: A comparative study of the systemic inflammatory response to hepatic resection, microwave ablation, cryotherapy and radiofrequency ablation : which is safest and how much can we safely ablate?
Author: Ahmad, Muhammad Fateh
ISNI:       0000 0004 2695 8735
Awarding Body: University of Leicester
Current Institution: University of Leicester
Date of Award: 2010
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Liver cancer, whether primary or secondary, is a common clinical condition which carries a high mortality. Up until the last 50 years or so, patients with these conditions were thought to be untreatable, confined to alternative medicine and with extremely poor survival rates. Surgical resection was in theory a viable option for tumours limited to the liver such as hepatocellular carcinomas and colorectal liver metastases; however this was accompanied by unacceptable morbidity and mortality rates. Newer surgical techniques, combined with anaesthetic and technological advances then allowed a subset of these tumours to be removed more safely, either as a debulking procedure or in its entirety. Attempts to resect larger tumours or malpositioned tumours (i.e. approximating major hepatobiliary structures) continued to be associated with high complication rates. Advances in chemotherapy led to some improvement in survival, although with high morbidity. Over the last 3 decades, clinicians have sought alternative ways of treating these tumours, partly to increase efficacy of treatment, but also to increase resectability and operability. It was widely recognised that for larger tumours, or tumours involving several segments, there was a need to leave the maximum amount of normal hepatic parenchyma by selectively destroying or removing the tumour-affected portion of the liver only. The 3- dimensional anatomy of the liver segments as described by Couinaud (1952) greatly improved our understanding of what was possible to resect or ablate (Figure 1.1). Thus evolved the concept in in-situ ablation whether thermal, chemical or ultrasonic. More recently, neoadjuvant and adjuvant chemotherapy have been used in treating these patients to downstage tumours and make them amenable to resection and/or ablation. Percutaneous and minimal access ablation procedures have also made possible multiple visits to treat recurrence in the same areas of the liver, whilst leaving as much normal hepatic parenchyma as possible. These advances have been facilitated by technological breakthroughs in imaging techniques, particularly crosssectional computed tomography and MRI.
Supervisor: London, Nicholas Sponsor: Not available
Qualification Name: Thesis (M.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available