Radiofrequency Ablation (RFA) of the Liver

  • Medical Author:
    Melissa Conrad Stöppler, MD

    Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

  • Medical Editor: Bhupinder S. Anand, MBBS, MD, DPHIL (OXON)
    Bhupinder S. Anand, MBBS, MD, DPHIL (OXON)

    Bhupinder S. Anand, MBBS, MD, DPHIL (OXON)

    Dr. Anand received MBBS degree from Medical College Amritsar, University of Punjab. He completed his Internal Medicine residency at the Postgraduate Institute of medical Education and Research, Chandigarh, India. He was trained in the field of Gastroenterology and obtained the DPhil degree. Dr. Anand is board-certified in Internal Medicine and Gastroenterology.

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What is radiofrequency ablation (RFA) of the liver?

Radiofrequency ablation (RFA) is a technique that uses high frequency electrical energy that creates heat, delivered through a thin instrument known as a probe, to destroy tissue. It is used in the liver to destroy tumors (either primary liver cancers or cancers that have metastasized or spread to the liver) that cannot be removed by traditional surgery.

Radiofrequency ablation also is  used in many other medical conditions. Examples of other uses of radiofrequency ablation include:

What are uses of radiofrequency ablation (RFA) of the liver?

Radiofrequency ablation is used to treat hepatocellular carcinomas (HCC) of the liver, primary cancers that arise in the liver cells, when these tumors are small and the patient is not an appropriate candidate for surgical removal of the tumor or liver transplantation. Radiofrequency ablation also can be used on liver tumors that have originated elsewhere in the body and have spread (metastasized) to the liver.

Liver Cancer Symptoms and Signs

Signs and symptoms of liver cancer arise most commonly in the later stages of the disease and include:

  • Chalky, white-colored stools
  • Fatigue
  • Weight loss
  • Nausea
  • Vomiting

What size tumor is treated by radiofrequency ablation (RFA)?

The maximum size for a liver tumor to be treated by ablation has not been established. However, radiofrequency ablation is best suited for tumors less than 5 cm. Larger tumors may require more than one session.

How do I prepare for radiofrequency ablation (RFA)?

Your doctor will give you specific instructions on how to prepare for the procedure. You may be advised to stop taking blood-thinner medications before the procedure and not to drink or eat anything for some hours beforehand. Depending on the type of radiofrequency ablation that is done, and whether or not anesthesia is required, you may be able to return home after the procedure, or you may remain overnight in the hospital.

What kind of equipment is used for radiofrequency ablation (RFA)?

Imaging procedures like CT (computed tomography) scan, ultrasound, or magnetic resonance imaging (MRI) are used to help guide the probe into the area of the tumor. The probe is designed like a long needle electrode through which a high-frequency electrical current is passed.

How does the radiofrequency ablation (RFA) procedure work?

Radiofrequency ablation can be performed in different ways. It may be administered during open surgery, laparoscopic surgery, or percutaneously (through the skin) using imaging studies to guide the placement of the probe. Interventional radiologists are the doctors who most commonly perform RFA through the skin, while surgeons may perform RFA during laparoscopic or open surgeries.

In all cases of radiofrequency ablation, a probe is inserted into the center of the tumor and the non-insulated electrodes, which are shaped like prongs, are projected out from the central probe into the tumor. The local heat that is generated melts the tissue (in a process known as coagulative necrosis) that is adjacent to the probe. The probe is left in place for about 10 to 15 minutes. For larger tumors it might be necessary to re-position the probe in different areas of the tumor. Imaging studies are done anywhere from a few hours to weeks after the procedure to ensure that the entire tumor tissue has been cauterized.

What can expect during radiofrequency ablation (RFA)?

Radiofrequency ablation may be done using local anesthesia or general anesthesia (typically if RFA is performed during surgery). Radiofrequency ablation performed by inserting the needle probe through the skin can be done under local anesthesia in which the skin insertion site is numbed. Typically, an intravenous line is placed for delivery of fluid and medications. Monitoring devices to measure heart rate and blood pressure are attached to the body.

How long does the procedure last?

Each radiofrequency ablation typically takes 10-30 minutes. Ablating more than one area requires more time. The entire procedure is usually finished in 1-3 hours. After the procedure, the patient remains in a recovery room until fully awake.

What are the risks and side effects of radiofrequency ablation (RFA) therapy?

Radiofrequency ablation is generally well-tolerated, and does not typically cause any serious pain after the treatment. There is a very low risk of bleeding or infection after the treatment as well as a low risk of injury to the gallbladder or bile ducts. Sometimes, a low-grade fever and flu-like symptoms may be present after the procedure for a few days.

 Other possible side effects of radiofrequency ablation include

  • post-procedure pain,
  • inflammation of the gallbladder, and
  • injury to the bowel.

What is the success rate of radiofrequency ablation (RFA) therapy?

In most studies, radiofrequency ablation is over 85% successful at destroying small liver tumors. Studies also show that over half of the tumors removed by radiofrequency ablation do not recur (come back). Because the treatment typically does not cause serious health risks, chemotherapy can be resumed (if needed) soon after the procedure. Radiofrequency ablation usually has few complications, and can be repeated if necessary for the same or additional tumors.

REFERENCES:

Curley, S. A., MD., et al. " Nonsurgical therapies for localized hepatocellular carcinoma: Radiofrequency ablation, percutaneous ethanol injection, thermal ablation, and cryoablation." UpToDate. Updated Oct 16, 2015.
<https://www.uptodate.com/contents/nonsurgical-therapies-for-localized-hepatocellular-carcinoma-radiofrequency-ablation-percutaneous-ethanol-injection-thermal-ablation-and-cryoablation>

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Reviewed on 6/3/2016
References
REFERENCES:

Curley, S. A., MD., et al. " Nonsurgical therapies for localized hepatocellular carcinoma: Radiofrequency ablation, percutaneous ethanol injection, thermal ablation, and cryoablation." UpToDate. Updated Oct 16, 2015.
<https://www.uptodate.com/contents/nonsurgical-therapies-for-localized-hepatocellular-carcinoma-radiofrequency-ablation-percutaneous-ethanol-injection-thermal-ablation-and-cryoablation>

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