Radiofrequency ablation (RFA) is a new technique used to treat benign and malignant liver tumors, often without the long incisions traditionally used in liver tumor ablation. In the past, destruction of liver tumors could only be accomplished by freezing (cryoablation) or injection with toxic chemicals. RFA combines the advantages of improved technology and minimally invasive surgery to give patients another option for treatment of liver tumors.
It is the preferred treatment when diseased tissue is small or cannot be surgically removed. It can be most frequently performed by our radiologists under ultrasound guidance using a probe passed through the skin and into the liver tumor. Sedation is required during the ablation procedure and patients return home typically the same day. This procedure has a high chance of cure for tumors less than about 1 inch in diameter and can be repeated if necessary.
How Does RFA Work?
Using intraoperative imaging of the tumor with ultrasound, an electrode is positioned strategically within the lesion. Then, the electrode is connected to a unique radiofrequency generator and electrical current is delivered into the tissue. As the cells are heated, they are destroyed. The mechanism of RFA is similar to that of a microwave oven, heating from the inside out. The body eliminates the destroyed tumor cells over a period of time.
Radiofrequency ablation can be performed using many different approaches, but usually requires surgery and general anesthesia to be done safely. In most cases laparoscopic surgery is used, employing small incisions with a camera placed inside the abdomen to guide the ablation procedure.
Typically three or four small incisions are made. Ports are then inserted into these incisions, which enable the surgeon to easily guide the radiofrequency and ultrasound probes into the liver (see illustration on reverse). The location of each incision depends upon the location of the tumor within the liver. In rare situations, the tumor may be too large for the laparoscopic approach, or may be located in an area that is not safe for laparoscopic surgery. In these cases, a traditional open incision will be used.
During surgery, a small ultrasound probe is also placed into the abdomen to accurately locate the tumor and guide the RFA probe into the center of the tumor. Patients typically spend four hours in surgery.
Radiofrequency ablation has many advantages over other ablation techniques, including:
• More effective tumor destruction
• Fewer complications
• Can be performed laparoscopically in most patients
• Usually requires only one treatment session
• Allows for faster recovery
On average, patients who undergo RFA spend two or three days in the hospital following surgery. While RFA can be repeated, this is rarely necessary.
Radiofrequency ablation is very safe, although it usually requires laparoscopic surgery. Therefore, the risks can include bleeding and the development of infections, and a small chance that your liver disease may become worse following ablation. There is also an exceedingly small chance (1 in 200) that the tumor may spread outside the liver during the operation. The majority of patients do not experience any complications following RFA.
Radiofrequency ablation is not for everyone. If you have severe portal hypertension, a very large tumor or your tumor has spread outside of the liver, the risk of undergoing RFA may outweigh the potential benefit. Only your doctors can determine if RFA is right for you.
The outcome of this procedure is very encouraging especially for persons with large tumor who are not in a position to withstand the stresses of conventional surgery. Single ablation requires around 10-30 minutes and in case of multiple ablations the procedure takes 1-3 hours. The patient is kept in the recovery room till the effect of sedation wears away. He is then permitted to go home. Very few patients experience any pain at the site of needle entry. This pain goes away in a week’s time and the person is then able to resume his daily activities.