Ablative and locoregional treatment options, such as radiofrequency, ethanol injection,
microwave, and cryoablation, as well as irreversible electroporation, are effective therapies
for early-stage hepatocellular carcinoma (HCC). Hepatocyte death caused by ablative
procedures is known to increase the release of tumor-associated antigen, thus enhancing
tumor immunogenicity. In addition, the heat ablative resection induces pyroptotic cell
death accompanied by the release of several inflammatory factors and immune-related
proteins, including damage-associated molecular patterns (DAMPs), heat shock proteins
(HSPs), ficolin 3, ATP, and DNA/RNA, which potentiate the antitumoral immune response.
Surgical approaches that enhance tumor necrosis and reduce hypoxia in the residual liver
parenchyma have been shown to increase the disease-free survival rate by reducing the
host’s immunosuppressive response. Scalpel devices and targeted surgical approach
combined with immune-modulating drugs are an interesting and promising area to
maximize therapeutic outcomes after HCC ablation.
