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Radiofrequency Ablation in 447 Complex Unresectable Liver Tumors: Lessons Learned


Background: Radiofrequency ablation (RFA) is a promising technique for unresectable hepatic malignancies. We reviewed our RFA experience to identify variables affecting local recurrence.

Methods: Patients undergoing RFA between 1997 and 2001 were reviewed for demographics, tumor size, pathology, diagnosis, recurrence, procedures, survival, and complications.

Results: The 447 unresectable liver tumors were ablated in 198 procedures. The 153 patients averaged 61.9 years of age and 1.25 RFA procedures per patient. Follow-up averaged 11 months. Serial ablations were performed in 28 patients, 8 of whom are without evidence of disease. Tumors were most commonly carcinomas of colorectal, hepatocellular, breast, and melanoma histologies. Colorectal carcinomas and hepatomas individually recurred more frequently than all other tumor types combined in univariate analyses (P = .009 and P = .008, respectively). Patients with multiple tumors ablated recurred significantly more frequently (P = .001). Size was also significant in univariate and multivariate analyses (P = .0032 and &<.0001, respectively). Eighteen patients experienced 36 complications.

Conclusions: Size has the highest correlation with local recurrence, but multiple tumors and pathology may also predict local recurrence risk. Large, complex lesions can be safely serially ablated, but because of morbidity and recurrence, RFA should not replace resection as the primary treatment of resectable liver tumors.

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  1. Huang SK, Graham AR, Wharton K. Radiofrequency catheter ablation of the left and right ventricles: anatomic and electrophysiologic observations. Pacing Clin Electrophysiol 1988; 11: 449–59.

    Google Scholar 

  2. Manolis AS, Wang PJ, Estes NA III. Radiofrequency catheter ablation for cardiac tachyarrhythmias. Ann Intern Med 1994; 121: 452–61.

    Google Scholar 

  3. Rossi S, Di Stasi M, Buscarini E, et al. Percutaneous radiofrequency interstitial thermal ablation in the treatment of small hepatocellular carcinoma. Cancer J Sci Am 1995; 1: 73.

    Google Scholar 

  4. Bilchik AJ, Rose DM, Allegra DP, Bostick PJ, Hsueh E, Morton DL. Radiofrequency ablation: a minimally invasive technique with multiple applications. Cancer J Sci Am 1999; 5: 356–61.

    Google Scholar 

  5. Jarnagin WR, Bodniewicz J, Dougherty E, Conlon K, Blumgart LH, Fong Y. A prospective analysis of staging laparoscopy in patients with primary and secondary hepatobiliary malignancies. J Gastrointest Surg 2000; 4: 34–43.

    Google Scholar 

  6. Rose DM, Allegra DP, Bostick PJ, Foshag LJ, Bilchik AJ. Radiofrequency ablation: a novel primary and adjunctive ablative technique for hepatic malignancies. Am Surg 1999; 65: 1009–14.

    Google Scholar 

  7. Bowles BJ, Machi J, Limm WML, et al. Safety and efficacy of radiofrequency thermal ablation in advanced liver tumors. Arch Surg 2001; 136: 864–9.

    Article  CAS  PubMed  Google Scholar 

  8. Wood TF, Rose DM, Chung M, Allegra DP, Foshag LJ, Bilchik AJ. Radiofrequency ablation of 231 unresectable hepatic tumors: indications, limitations and complications. Ann Surg Oncol 2000; 7: 593–600.

    CAS  PubMed  Google Scholar 

  9. Wong SL, Edwards MJ, Chao C, Simpson D, McMasters KM. Radiofrequency ablation for unresectable hepatic tumors. Am J Surg 2001; 182: 552–7.

    Article  CAS  PubMed  Google Scholar 

  10. Yamagata M, Matsumata T, Ikeda Y, Hayashi H, Sugimachi K. Recurrence near the resection line of hepatocellular carcinoma in the anterosuperior subsegment of the liver—the effect of the argon beam coagulator. Hepatogastroenterology 1995; 42: 9–12.

    Google Scholar 

  11. Yamasaki T, Kurokawa F, Shirahashi H, Kusano N, Hironaka K, Okita K. Percutaneous radiofrequency ablation therapy with combined angiography and computed tomography assistance for patients with hepatocellular carcinoma. Cancer 2001; 91: 1342–8.

    Google Scholar 

  12. Curley SA, Izzo F, Delrio P, et al. Radiofrequency ablation of unresectable primary and metastatic hepatic malignancies: results in 123 patients. Ann Surg 1999; 230: 1–8.

    Article  CAS  PubMed  Google Scholar 

  13. Curley SA, Izzo F, Ellis LM, Vauthey JN, Vallone P. Radiofrequency ablation of hepatocellular cancer in 110 patients with cirrhosis. Ann Surg 2000; 232: 381–91.

    Article  CAS  PubMed  Google Scholar 

  14. Patterson EJ, Scuadamore CH, Owen DA, Nagy AG, Buczkowski AK. Radiofrequency ablation of porcine liver in vivo: effects of blood flow and treatment time on lesion size. Ann Surg 1998; 227: 559–65.

    Article  CAS  PubMed  Google Scholar 

  15. de Baere T, Elias D, Dromain C, et al. Radiofrequency ablation of 100 hepatic metastases with a mean follow-up of more than 1 year. AJR Am J Roentgenol 2000; 175: 1619–25.

    Google Scholar 

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Correspondence to Anton J. Bilchik MD, PhD.

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Bleicher, R.J., Allegra, D.P., Nora, D.T. et al. Radiofrequency Ablation in 447 Complex Unresectable Liver Tumors: Lessons Learned. Ann Surg Oncol 10, 52–58 (2003).

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Key Words

  • Radiofrequency ablation
  • Hepatic metastases
  • Recurrence
  • Serial ablations