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Radiofrequency Ablation of Unresectable Hepatic Malignancies: Lessons Learned

^a Department of Surgical Oncology, John Wayne Cancer Institute, Santa Monica, California, USA; ^b the Cancer Center at Century City Hospital, Los Angeles, California, USA

Correspondence: Anton J. Bilchik, M.D., Ph.D., F.A.C.S., John Wayne Cancer Institute, 2200 Santa Monica Boulevard, Santa Monica, California 90404, USA. Telephone: 310-449-5206; Fax: 310-449-5261; e-mail: bilchika{at}jwci.org

Radiofrequency ablation (RFA) is increasingly used for the local destruction of unresectable hepatic malignancies. Relative contraindications include tumors in proximity to vital structures that may be injured by RFA and lesions whose size exceeds the ablation capabilities of the probe system employed. Given current technology, we believe that RFA should be cautiously utilized for lesions greater than 5 cm in diameter. Open (celiotomy) and laparoscopic approaches to RFA allow intraoperative ultrasonography, which may demonstrate occult hepatic disease. In addition, RFA performed via celiotomy can be accompanied by resection or cryosurgical ablation, and isolation of the liver from adjacent organs. Percutaneous RFA should be reserved for patients who cannot undergo general anesthesia, those with recurrent or progressive lesions, and those with smaller lesions sufficiently isolated from adjacent organs. Complications may be minimized when these approaches are selectively applied.

Key Words. Radiofrequency ablation • Hepatic malignancies

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