Applications of electrosurgery: radio frequency ablation of liver tumors

Abstract

Radio frequency ablation (RFA) is an evolving technology that is under investigation for the treatment of a wide variety of tumors. Radio frequency ablation has been studied in the treatment of heart, breast, lung, adrenal, renal, brain, prostate, and bone tumors. But its largest area of application has been the treatment of liver tumors, and it is not far short of general clinical use. Radio frequency ablation holds particular promise for the treatment of liver tumors. Like cryosurgery, it offers the ability to precisely ablate the tumor while causing only minimal injury to the surrounding hepatic parenchyma. This is especially important in the liver, because surgical resection is quite often impossible, even for primary liver tumors. Hepatocellular carcinoma can be treated with curative surgical resection in only 5% to 15% of newly diagnosed cases. The remainder have multifocal disease, tumor close to or invading significant vascular or biliary structures, or inadequate functional reserve due to coexistent cirrhosis. For these patients RFA offers a chance for destruction of the tumor without the resection of normal hepatic parenchyma seen with standard surgical resection. Radio frequency ablation has been studied in the treatment of metastatic liver tumors as well. Long-term survival benefit in 20% to 35% of patients undergoing resection of isolated liver metastasis has been demonstrated with standard surgical resection. Unfortunately, only 10% to 15% of patients with metastatic liver tumors are candidates for resection. Tumors may be unresectable due to bilobar disease, more than 4 metastases, or proximity to major vascular or biliary structures. Radio frequency ablation may allow for destruction of otherwise inoperable tumors.