Radiofrequency thermal ablation (RFA) of liver tumors: percutaneous and open surgical approaches

Radiofrequency Thermal Ablation (RFA) of liver tumors is done by percutaneous, laparoscopic and open surgical approach. Selection criteria for percutaneous or open surgical ablation of 65 hepatic lesions are here evaluated in 45 patients treated in a two-years period. Twenty-five patients were males and 20 females, ages ranged from 35 to 80 years (mean 63 years). RFA was performed in 57 procedures, ablating 14 hepatomas and 51 liver metastases. In 10 cases the treatment was repeated twice. Tumor size ranged from 0.5 cm to 8 cm, with a mean of 2.4 cm. Open surgical approach was performed in 14 cases (24.6%), seven of which were simultaneously treated for associated diseases. Percutaneous treatment was adopted in 43 cases (75.4%). A laparoscopic approach was not tempted in any case. Morbidity was 8.8%, mostly in open surgery (4 cases or 28.6%) but in one patient (2.3%) with percutaneous approach. Difference in between the two groups was statistically significant (p=0.013). Overall mortality was 2.2%: one patients deceased for myocardial infarction. The mean length of hospital stay was of 4.1 days for the percutaneous treatment group and 7.6 days for the open surgery approach. Number of the lesions did not interfere with surgical approach. Postoperative CT control showed no differences, in terms of complete ablation of the tumor, between the two groups of patients. Advantages of percutaneous approach include less invasiveness, reduced postoperative pain, shorter hospitalization, reduced costs and lower discomfort in repeating the procedure. In addition, open surgical RFA allows better cancer staging, avoidance of adjacent organ injury, accessibility to all liver areas and gives the chance to performe simultaneous organ resection. These results are encouraging in making the percutaneous approach of RFA the method of choice in these patients.