Narrative review of 3D navigated stereotactic liver ablation—do we still need a minimally invasive liver surgeon?

Ablation is an exciting alternative to surgery as a curative intent treatment for primary and metastatic liver cancer. However, conventional techniques have not achieved oncologic outcomes equal to surgery except in a minimal subset of patients. We discuss here our use of a stereotactic technique for RFA and summarize the available clinical evidence for this approach to make oncological outcomes of ablation therapy comparable to surgery. Even with promising results, we are the only institution performing this approach, and similar approaches are only made in a few centers worldwide. The causes for that are multifactorial, but reimbursement of percutaneous ablation seems to be the most significant limiting factor for this technology becoming mainstream. Nonetheless, the question to answer is: will stereotactic liver ablation replace minimally invasive liver resection? In our opinion, stereotactic liver ablation will change the way we treat primary and metastatic liver cancer, but ideally, by adding another viable and consistent minimally invasive option. The objective is offering curative intent treatments to more patients and making open procedures become a last resort option. To get there, surgeons and interventional radiologists have to work together to create the clinical evidence and knowhow to make this a reality.