The Evolving Role of Hepatic Ablation with Dr. Raul Uppot

Dr. Raul Uppot, MD, from Massachusetts General Hospital, delivered a comprehensive presentation on the dynamic landscape of hepatic ablation during CIO 2023. 

Dr. Raul Uppot, MD, from Massachusetts General Hospital, delivered a comprehensive presentation on the dynamic landscape of hepatic ablation during the 2023 Symposium on Clinical Interventional Oncology. His discourse covered various facets of this evolving field, delineating insights gleaned from recent research studies and case reports.
 
A noteworthy point of emphasis was the substantial global growth of hepatic ablation, reflecting a surge from 1.5 billion to a projected 4.3 billion. Dr. Uppot underscored the burgeoning utilization of ablation, particularly in North America and the rapidly expanding market in Asia.
 
The equivalence of ablation to transplantation in certain scenarios was a focal point of discussion. Drawing from studies, Dr. Uppot illustrated that, while thermal ablation exhibited higher recurrence rates compared to transplantation, overall survival rates were notably equivalent. This nuanced perspective suggested that ablation could serve as a safe and effective alternative in specific cases, particularly those involving clinical-assisted portal hypertension.
 
The integration of advanced tools and techniques in hepatic ablation emerged as a crucial theme. Dr. Uppot delved into the combination of Y90 and microwave ablation, presenting findings that supported the efficacy of this approach, particularly when guided by cone beam CT. Moreover, the presentation highlighted the expanding use of MRI and cone beam CT, with a specific focus on open-ended MR units and their potential for real-time procedures.
 
Dr. Uppot also shed light on innovative pain management strategies, notably hepatic hilum nerve blocks, showcasing their potential to reduce the need for sedation during procedures. Additionally, he touched upon the evolving technology landscape, exemplified by the incorporation of microwave and radiofrequency tools on endoscopes, demonstrating the ongoing efforts to enhance procedural precision.
 
Advances in imaging techniques, including the integration of machine learning and radiomics, were presented as valuable tools for predicting treatment success. Dr. Uppot referenced his institution's research, which examined pre-procedural images to gauge the likelihood of success in hepatic transplant cases, underlining the potential of these technologies in refining treatment strategies.
 
The presentation also addressed strategies to avoid complications, with a focus on antibiotic use and considerations for minimizing risks associated with procedures near bile ducts. Dr. Uppot sounded a note of caution regarding irreversible electroporation (IRE) and post-electrical field ablation, emphasizing the need for vigilance in monitoring potential seeding and recurrence.
 
In conclusion, Dr. Uppot provided a comprehensive overview of the evolving landscape of hepatic ablation, offering valuable insights into outcomes, innovative techniques, imaging advancements, and strategies to mitigate complications. His presentation contributed significantly to the ongoing discourse within the clinical interventional oncology community.