Radiofrequency Ablation of Liver Tumors

Who radiofrequency ablation is suitable for

Ablation is considered in several situations:

• colorectal liver metastases — small lesions located deep in the organ;
• as an addition to resection: some lesions are removed, and the rest are destroyed by ablation during the same procedure;
• liver cancer with small nodules — including when resection is contraindicated because of the condition of the liver;
• a new lesion after a previous liver operation, if the conditions for a procedure are met again.

The decision on the method is made at a tumor board — together with medical oncologists and radiologists: ablation is usually part of a broader treatment plan rather than a separate procedure.

When ablation is not suitable

• The lesion is too large. Ablation is intended for small lesions — up to 3 cm; for larger ones resection is usually preferred, if it is safe for the liver.
• The lesion lies next to major vessels. Blood flow carries heat away, and the part of the tumor near the vessel may not be heated enough.
• Major bile ducts or neighboring organs are nearby. Heating may damage them.

Ablation is not an “easier operation of choice”. It is a separate tool with its own indications, and in some cases it does not replace resection.

How ablation is performed

The electrode is guided to the lesion under imaging control, and the tumor is heated together with a narrow rim of healthy tissue around it. The lesion can be reached in three ways.

Which way is suitable depends on the location of the lesion, the number of lesions and whether resection is needed at the same time. From the images we make a preliminary assessment of the possible routes; the final choice is made after a full assessment. The procedure is performed under anesthesia.

Ablation or resection

The possibility of resection does not in itself rule out ablation. For a solitary hepatocellular carcinoma up to 2 cm, resection and ablation are alternatives in defined groups of patients. For a solitary tumor larger than 2 cm with preserved liver function and a sufficient liver remnant, guidelines recommend resection, and ablation is considered individually. The question is not always “either — or”: in selected patients resection and ablation are combined to treat all lesions and preserve as much healthy liver as possible.

After ablation: recovery and follow-up

The length of the hospital stay depends on the approach: after ablation through a puncture it is usually shorter than after open surgery.

The result is assessed on follow-up contrast-enhanced CT or MRI: they are checked for signs of residual viable tumor. As after resection, a new lesion may appear in the liver over time — so follow-up examinations are repeated. If a lesion is found, the possibility of ablation or resection is assessed again.

Possible complications are bleeding, infection, and damage to the bile ducts or neighboring organs. Their likelihood depends on the location of the lesion and the approach. I will explain the risks in your particular case at the consultation.

What is needed to assess whether ablation is suitable

• contrast-enhanced CT or MRI discs of the liver — recent ones, with the images, not only the reports;
• the histopathology report, if a histological examination was performed;
• records of previous treatment: operations, chemotherapy regimens and number of courses;
• recent blood tests, including liver function tests and tumor markers if they were measured.

Bring the documents to a consultation or send them in advance if you are from another city — how to do this is described on the page “Online Oncologist Consultation”.