Radiofrequency ablatian of 231 unresectable hepatic tumors: Indications, limitations, and complications

Background: Radiofrequency ablation (RFA) is increasingly used for the loca l destruction of unresectable hepatic malignancies. There is little informa tion on its optimal approach or potential complications. Methods: Since late 1997, we have undertaken 91 RFA procedures to ablate 23 1 unresectable primary or metastatic liver tumors in 84 patients. RFA was p erformed via celiotomy (n = 39), laparoscopy (n = 27), or a percutaneous ap proach (n = 25). Patients were followed with spiral computed tomographic (C T) scans at 1 to 2 weeks postprocedure and then every 3 months for 2 years. Results: Intraoperative ultrasound (IOUS) detected intrahepatic disease not evident on the preoperative scans of 25 of 66 patients (38%) undergoing RF A via celiotomy or laparoscopy. In 38 of 84 patients (45%), RFA was combine d with resection or cryosurgical ablation (CSA), or both. RFA was used to t reat an average of 2.8 lesions per patient, and the median size of treated lesions was 2 cm (range, 0.3-9 cm). The average hospital stay was 3.6 days overall (1.8 days for percutaneous and laparoscopic cases). Ten patients un derwent a second RFA procedure (sequential ablations) and, in one case, a t hird RFA procedure for large (one patient), progressive (seven patients), a nd/or recurrent (three patients) lesions. Seven (8%) patients had complicat ions: one skin burn; one postoperative hemorrhage; two simple hepatic absce sses; one hepatic abscess associated with diaphragmatic heat necrosis follo wing sequential percutaneous ablations of a large lesion; one postoperative myocardial infarction; and one liver failure. There were three deaths, one (1%) of which was directly related to the RFA procedure. Three of the comp lications, including one RFA-related death, occurred after percutaneous RFA . At a median follow-up of 9 months (range, 1-27 months), 15 patients (18%) had recurrences at an RFA site, and 36 patients (43%) remained clinically free of disease. Conclusions: Celiotomy or laparoscopic approaches are preferred for RFA bec ause they allow IOUS, which may demonstrate occult hepatic disease. Operati ve RFA also allows concomitant resection, CSA, or placement of a hepatic ar tery infusion pump, and isolation of the liver from adjacent organs. Percut aneous RFA should be reserved for patients at high risk for anesthesia, tho se with recurrent or progressive lesions, and those with smaller lesions su fficiently isolated from adjacent organs. Complications may be minimized wh en these approaches are applied selectively.