title: Radiofrequency ablation of unresectable hepatic malignancies: lessons learned.
abstract: 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.
authors.affiliation: Department of Surgical Oncology, John Wayne Cancer Institute, Santa Monica, California 90404, USA. bilchika@jwci.org
authors.forename: A J
authors.initials: AJ
authors.lastname: Bilchik
authors.forename: T F
authors.initials: TF
authors.lastname: Wood
authors.forename: D P
authors.initials: DP
authors.lastname: Allegra
mesh_terms: D000465:Algorithms; D017115:Catheter Ablation / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000379:methods; D008113:Liver Neoplasms / Q000473:pathology / Q000601:surgery*; D009364:Neoplasm Recurrence, Local / Q000601:surgery; D018579:Patient Selection