The role of radiofrequency ablation in the treatment of primary and metastatic tumours of the liver: initial lessons learned.
OBJECTIVE
The majority of patients with hepatic malignancies are not suitable for potentially curative resection due to tumour size, location, inadequate hepatic reserve or widely spread disease. Radiofrequency ablation (RFA) is a novel technique of local tumour destruction by heat. The aim of this study was to report the initial experience with RFA in the management of primary and metastatic liver tumours in New Zealand.


METHODS
Patients who underwent RFA between February 2000 and August 2001 were included. The clinical, pathological and follow-up information of individual patients entered prospectively on a computerised database was collated and analysed.


RESULTS
Thirty one procedures were performed in 30 patients (18 male, median age 58 years). Nineteen procedures were performed percutaneously under ultrasound guidance and twelve were carried out as part of a surgical procedure. Eight patients had primary tumours, and 22 patients had metastatic tumours (colorectal 9, neuroendocrine 7, non-colorectal non-neuroendocrine 6). The median diameter of treated lesions was 25 mm (range 5 60 mm). The median number of treated lesions per patient was 2 (range 1 6). Twenty four of the 31 procedures were classified as curative (all disease treated). Six patients with neuroendocrine tumours underwent cytoreduction only and were classified as palliative. Eight patients (4 percutaneous, 4 surgical) developed complications leading to 3 prolonged hospital stays (bile leak, abscess and burn). There was no treatment-related mortality. At a median follow up of 12 months (range 1 22 months), 6 patients (all treated with percutaneous RFA) have developed tumour recurrence in treated lesions, 5 patients have developed new liver lesions, 16 are alive and disease free, and 3 have developed extra hepatic disease.


CONCLUSIONS
RFA is safe but significant complications can occur. RFA and enteral resection should not be undertaken together, as there is an increased risk of hepatic sepsis and abscess. RFA performed percutaneously is associated with a higher rate of recurrence than RFA performed at operation.
D000293:Adolescent; D000328:Adult; D000368:Aged; D017115:Catheter Ablation / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007902:Length of Stay; D008113:Liver Neoplasms / Q000473:pathology / Q000556:secondary / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D009520:New Zealand; D015996:Survival Rate; D016896:Treatment Outcome