Radiofrequency ablation prior to liver transplantation: focus on complications and on a rare but severe case.
BACKGROUND
Radiofrequency ablation (RFA) is an established treatment for hepatocellular carcinoma (HCC) in patients awaiting liver transplantation, due to its comparably low rate of complication and high effectiveness. Complications are thought to be rare and mostly self-limiting. By contrast, we report on a life-threatening complication and discuss it in the context of other complications.


METHODS
Out of a total of 149 RFA procedures, the incidence of major complications was 4% on a per-procedure basis. Mortality was 0.67%. Major complications included intractable pain, intrahepatic hematoma, skinburn at the site of patch electrode, and sectorial bile duct stricture. All complications occurred after percutaneous RFA. Highlighted is a young patient listed for liver transplantation because of HCC recurrence following hepatic resection, who was treated by percutaneous RFA as a bridging therapy until a suitable graft became available. Post-operatively, gastric perforation occurred due to heat injury of the gastric wall.


CONCLUSIONS
The percutaneous RFA approach can occasionally lead to detrimental complications, particularly in patients with intra-abdominal adhesions, due to previous surgery if new intrahepatic malignant lesions accrue near the resection margin. Even widespread HCC disease can be treated effectively with orthotopic liver transplantation if the tumor growth is limited to the liver.
Eisele
Robert M
RM
Department of General, Visceral & Transplantation Surgery, Charité Virchow-Clinic, Berlin, Germany. robert_m.eisele@charite.de
Schumacher
Guido
G
Jonas
Sven
S
Neuhaus
Peter
P
D000328:Adult; D001650:Bile Duct Neoplasms / Q000601:surgery; D001653:Bile Ducts, Intrahepatic; D006528:Carcinoma, Hepatocellular / Q000601:surgery*; D017115:Catheter Ablation / Q000009:adverse effects* / Q000379:methods; D018281:Cholangiocarcinoma / Q000601:surgery; D049448:Cholangiopancreatography, Magnetic Resonance; D003131:Combined Modality Therapy; D005260:Female; D006498:Hepatectomy; D006801:Humans; D007431:Intraoperative Complications / Q000209:etiology*; D010535:Laparoscopy; D008113:Liver Neoplasms / Q000601:surgery*; D016031:Liver Transplantation; D008279:Magnetic Resonance Imaging; D009364:Neoplasm Recurrence, Local / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology; D013270:Stomach / Q000293:injuries*