Ultrasound-guided radiofrequency thermal ablation of liver tumors: Percutaneous, laparoscopic, and open surgical approaches

Only 10% to 20% of patients with primary and colorectal metastatic liver tu mors are candidates for curative surgical resection. Even after curative tr eatment, tumors recur commonly in the liver. As a less invasive therapy, ra diofrequency thermal ablation (RFA) of primary, metastatic, and recurrent l iver tumors was performed under percutaneous, laparoscopic, or open intraop erative ultrasound guidance. The safety and local control efficacy of RFA w ere investigated. RFA was performed mostly in patients with unresectable he patomas or metastatic liver tumors. Patients with large tumors, major vesse l or bile duct invasion, limited extrahepatic metastases, or liver dysfunct ion were not excluded. An RFA system with a 15-gauge electrode-cannula with four-pronged retractable needles was used. All patients were followed for more than 8 months to assess morbidity and mortality, and to determine tumo r recurrence. Sixty RFA operations were performed in 46 patients: 11 patien ts under-went repeat RFA once or twice. A total of 204 tumors were treated: 70 hepatomas and 134 metastatic tumors. Tumor size ranged from 5 mm to 180 mm (mean 36 mm). RFA was performed in 29 operations for 81 tumors percutan eously, in seven operations for 14 tumors laparoscopically, and in 24 opera tions for 109 tumors by open surgery. Combined colorectal resection was car ried out in five operations and combined hepatic resection was carried out in three operations. There was one death (1.7%) from liver failure, and the re were three major complications (5%): one case of bile leakage and two bi liary strictures due to thermal injury. There were no intraabdominal infect ious or bleeding complications. The length of hospital stay ranged from 0 t o 2, 1 to 3, and 4 to 7 days for percutaneous, laparoscopic, and open surgi cal RFA, respectively. During a mean follow-up period of 20.5 months, local tumor recurrence at the REA, site was diagnosed in 18 (8.8%) of 204 tumors . The risk factors for local recurrence included large tumor size and major vessel invasion: recurrence rates for tumors less than 4 cm, 4 to 10 cm, a nd greater than 10 cm, and for those with vessel invasion were 3.3%, 14.7%, 50%, and 47.8%, respectively. Ten of 18 tumors recurring locally were retr eated by RFA, and eight of them showed no further recurrence. Ultrasound-gu ided RFA is a relatively safe, well-tolerated, and versatile treatment opti on that offers excellent local control of primary and metastatic liver tumo rs. The appropriate use of percutaneous, laparoscopic, and open surgical RF A is beneficial in the management of patients with liver tumors in a variet y of situations.