title: [Local recurrence following hepatic radiofrequency ablation: diagnosis and treatment].
abstract: BACKGROUND
  Radiofrequency ablation (RFA) is an established treatment in irresectable malignant liver disease. The most severe constraint is re-occurrence at site of ablation. Whereas factors influencing local recurrence rates have been determined, little is known about the timespan within local recurrence (LR) is to be expected, and further treatment options.
  
  
  METHODS
  In the presented trial, RFA was performed using two different types of monopolar devices. All procedures were conducted under general anesthesia. Follow-up examinations took part after 3, 6, 12 months and annually.
  
  
  RESULTS
  149 RFAs in 125 patients were enrolled. Percutaneous access was chosen in 74 cases (50%), laparoscopic in 15 (10%) and open surgical in 60 cases (40%). Indications were primary liver tumors in 99 (67%) and metastases in 50 cases (33%). Overall LR rate was 29.5% on a per-patient- and 19.7% on a per-tumor-basis. The majority of LRs (71%) occurred within 9 months after the RFA despite observations beyond 2 years following the treatment (Figure 1). 75% of LR could be treated by targeted interventions (RFA, n = 18, 53%, laser-induced thermo therapy (LITT), n = 2.6%, brachytherapy, n = 2.6% or transarterial chemoembolisation (TACE), n = 2.6%) or resection (n = 6.18%); 4 patients underwent liver transplantation (12%) (Figure 2).
  
  
  CONCLUSIONS
  Local recurrence can be considered rather common after RFA. It is observed during the first 3 years of the follow-up period, and schedules have to be designed according to this finding. Follow-on treatment is feasible in approximately 75% of LR. Factors influencing the secondary success of repeated procedures have yet to be determined.
authors.affiliation: Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Charité Campus Virchow-Klinikum, Berlin, Germany. robert_m.eisele@charite.de
authors.forename: Robert M
authors.initials: RM
authors.lastname: Eisele
authors.forename: Guido
authors.initials: G
authors.lastname: Schumacher
authors.forename: Peter
authors.initials: P
authors.lastname: Neuhaus
mesh_terms: D000368:Aged; D017115:Catheter Ablation / Q000009:adverse effects*; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology / Q000556:secondary / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D015996:Survival Rate