Complications of radiofrequency ablation of hepatic tumors: Frequency and risk factors

Abstract

Radiofrequency ablation (RFA) has become an important option in the therapy of primary and secondary hepatic tumors. Surgical resection is still the best treatment option, but only a few of these patients are candidates for surgery: multilobar disease, insufficient liver reserve that will lead to liver failure after resection, extra-hepatic disease, proximity to major bile ducts and vessels, and co-morbidities. RFA has a low mortality and morbidity rate and is considered to be safe. Thus, complications occur and vary widely in the literature. Complications are caused by thermal damage, direct needle injury, infection and the patient's co-morbidities. Tumor type, type of approach, number of lesions, tumor localization, underlying hepatic disease, the physician's experience, associated hepatic resection and lesion size have been described as factors significantly associated with complications. The physician in charge should promptly recognize high-risk patients more susceptible to complications, perform a close post procedure follow-up and manage them early and adequately if they occur. We aim to describe complications from RFA of hepatic tumors and their risk factors, as well as a few techniques to avoid them. This way, others can decrease their morbidity rates with better outcomes.

Radiofrequency ablation of hepatocellular carcinoma: Mono or multipolar?

“…Some authors have described the use of artificial pleural effusion to separate the lung from the diaphragm, and the use of artificial ascites to separate the lesion from the diaphragm. 25,26 Our observations lend credence to the usefulness of these precautions.…”

Impact of Radiofrequency Ablation-Induced Glisson’s Capsule-Associated Complications in Patients with Hepatocellular Carcinoma

“…AP fistula occurs secondary to percutaneous liver procedures, such as liver biopsy, transhepatic bile-duct drainage, and RFA [19–22]. However, to the best of our knowledge, AP fistula wasn’t included as a complication due to RFA in previous studies [6, 23–24]. This might be because they highlighted complications immediately after RFA.…”

Ultrasound-Guided Percutaneous Radiofrequency Ablation of Liver Metastasis From Ovarian Cancer: A Single-Center Initial Experience

“…Most RFA series report morbidity as low as 2% to 5.7% and mortality of less than 1%, 24,25 whereas liver resection is associated with a morbidity of approximately 25% and mortality of less than 5%. 26 Major complications of RFA, such as postoperative hemorrhage, hepatic abscess, and biliary fistula, were not observed in the present study.…”