Liver neoplasms

Indications:

• primary solid liver tumors (adenomas, hemangiomas, hepatocarcinomas);
  
• secondary lesions (metastases)

Ablation is performed both for the purpose of healing and for the purpose of cytoreduction. The technology does not depend on the histological structure of the tumor, except for the «ablation rim» - capture of one cm of healthy tissue around a malignant focus.

Contraindications:

• multiple (more than 5) foci;
  
• unresolved jaundice;
  
• cholangitis;
  
• cirrhosis of the liver of class C according to the Child-Pugh classification;
  
• thrombocytopenia with a platelet count below 50x103/ml;
  
• decrease in prothrombin activity less than 50 %;
  
• tumor thrombosis of the portal vein and its branches;
  
• thrombosis of the inferior vena cava;
  
• cachexia with distant metastasis.

Preoperative examination:

• Ultrasound with biopsy for histological and IHC studies;
  
• CT or MRI with contrast enhancement;
  
• if it is necessary, PET-CT;
  
• standard clinical and laboratory examination for admission to the surgical department.

Preparation:

• "water diet" for 3 days: there are pureed soups, broths, copious drinking, puree, pureed porridge; the goal is to flood the loops of the small intestine with liquid contents and expel air from the intestine;
  
• all products that cause bloating of the intestine are prohibited;
  
• three days of Espumisan 3-5 capsules 3 times a day, preferably liquid Espumisan 1 tablespoon 3 times a day;
  
• if the focus is located high, under the diaphragm, it may be necessary to apply an artificial hydrothorax: the introduction of 800 ml of saline solution into the pleural cavity to create optimal access and good visualization of the foci.