Removal of liver tumours using radiofrequency waves

In the treatment of early and intermediate hepatocellular carcinoma the range of indications for percutaneous ablation techniques is becoming wider than surgery or intra-arterial therapies. Although it is understood that partial resection assures the highest local control, the survival rates after surgery are roughly comparable with those obtained with PEI or RF ablation. The explanation is due to a balance among advantages and disadvantages of the two therapies. Survival curves with percutaneous ablation techniques are better than curves of resected patients who present adverse prognostic factors, and this means that surgery needs a better selection of the patients. Indications for both of therapies are reported. An open question remains the choice among different ablation procedures. In our department we currently use RF ablation in the majority of patients but consider PEI and segmental TACE complementary, and use them according to the features of the disease and the response. In the treatment of colorectal metastases, the initial survival curves of RF ablation are promising. As treatment is size and site dependent, partial resection remains the gold standard. However, on the basis of the studies on "test of time", a possible candidate could be a patient presenting operable lesions with favourable criteria for a complete ablation. An interesting indication seems to be the treatment of breast liver metastases in selected patients.