Major Complications after Radio-frequency Thermal Ablation of Hepatic Tumors: Spectrum of Imaging Findings

Abstract

Although radio-frequency (RF) ablation has been accepted as a promising and safe technique for treatment of unresectable hepatic tumors, investigation of its complications has been limited. According to the multicenter (1,139 patients in 11 institutions) survey data of the Korean Study Group of Radiofrequency Ablation, a spectrum of complications occurred after RF ablation of hepatic tumors. The prevalence of major complications was 2.43%. The most common complications were hepatic abscess (0.66%), peritoneal hemorrhage (0.46%), biloma (0.20%), ground pad burn (0.20%), pneumothorax (0.20%), and vasovagal reflex (0.13%). Other complications were biliary stricture, diaphragmatic injury, gastric ulcer, hemothorax, hepatic failure, hepatic infarction, renal infarction, sepsis, and transient ischemic attack. One procedure-related death (0.09%) occurred (due to peritoneal hemorrhage). Three important strategies for decreasing the rate of complications are prevention, early detection, and proper management. A physician who performs RF ablation of hepatic malignancies should be aware of the broad spectrum of major complications so that these strategies can be used.

Radiofrequency ablation for hepatocellular carcinoma in so-called high-risk locations

“…36 While there was no difference in early complication rates according to tumor location, the overall early complication rate of 4.2% in this study may be slightly higher than those reported in other studies. 21,37 The effort of thorough ablation increased the total number of electrode insertions, and this may have led to an increase in complications. Nevertheless, we believe that this will be well compensated by the improved prognosis resulting from complete ablation.…”

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

“…Abdominal infection is also a common complication encountered [12,20] . This group of complications consists of hepatic abscess, wound infection and sepsis.…”

“…CT scan confirms the diagnosis; air bubbles are usually seen in the abscess. Thus, they may be seen in the ablated area after the procedure and this must not be misdiagnosed as an abscess [20] . Antibiotic prophylaxis is controversial in all patients, but in high risk cases it is recommended [6,12,22,23] .…”

Radiofrequency ablation: technique and clinical applications

“…Careful selection of appropriate patients and RF ablation tools, as well as utilization of adjunctive maneuvers are important to prevent complications. In order to decrease the risk of postprocedural bleeding and tumor seeding, exophytic tumors should be avoided, and a transhepatic route rather than a direct route should be selected to approach peripheral tumors (20). Also, the puncture site should be selected as anteriorly and inferiorly as possible, to prevent a pneumothorax because the pleural space extends more inferiorly in the posterior chest.…”

“…Patients with biliary dilatations have an increased risk of developing a postprocedural abscess or sepsis because of bacterial colonization in the biliary tract. Prophylactic use of antibiotics may be beneficial for these patients who are at higher risk for developing infection (20).…”