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Radiofrequency Ablation for Liver Tumours

What radiofrequency ablation does

Radiofrequency ablation destroys a liver tumour with heat, without removing part of the liver. A fine needle electrode is placed into the tumour under imaging guidance and radiofrequency current heats the tissue around the tip until the tumour and a small rim of liver around it are destroyed. The dead tissue is left in place and the body clears it slowly over months.

It is a treatment for the tumour, not for the underlying liver disease. In a cirrhotic liver the cirrhosis continues and surveillance continues with it.

When ablation is considered

Ablation is considered for a small liver tumour where removing part of the liver is not the better option. The usual situations are:

  • Hepatocellular carcinoma in a cirrhotic liver, with a lesion up to about 3 cm
  • Up to three lesions, each under 3 cm
  • Selected colorectal liver metastases, either on their own or alongside a resection in the same operation
  • A patient whose liver function or general fitness does not allow a major resection
  • Recurrence in a liver that has already been operated on

Size matters more than most people expect. Below 3 cm the whole tumour and a margin around it can be heated reliably. Above that, heat delivery becomes uneven and the chance of leaving viable tumour at the edge rises, which is why larger lesions are usually resected rather than ablated.

When ablation is not the right choice

  • A tumour sitting against a major bile duct, where heat risks a bile duct injury and a later stricture
  • A tumour against bowel or stomach, where the heat has nowhere safe to go
  • A lesion that cannot be reached safely, percutaneously or at operation
  • Disease that is too extensive for local treatment to change the outcome

Position, not just size, decides. A 2 cm tumour in an awkward place may be less suitable for ablation than a 3 cm tumour in the middle of the right lobe.

How it is done

There are two routes. Percutaneously, through the skin under ultrasound or CT guidance, usually as a day case or a single overnight stay. Or during an operation, laparoscopically or open, when ablation is combined with a resection or when the tumour cannot be reached safely from outside.

Which route is used depends on where the tumour sits, whether anything else is being done at the same time, and how well the lesion can be seen on imaging.

Recovery

Most people are sore over the ablation site for a few days and tired for one to two weeks. A low-grade fever and a general flu-like feeling in the first week is common and expected — it is the body responding to the destroyed tissue, not an infection.

The first scan is usually at four to six weeks. That scan is not a formality: it is how completeness of ablation is judged, and if a rim of tumour has survived, a second ablation is discussed then.

Ablation compared with resection

Resection removes the tumour and the liver around it, and the pathologist can then measure the margin. Ablation destroys the tumour in place, so there is no specimen and completeness is judged on imaging instead.

Resection asks more of the liver and of the patient. Ablation asks less, and can be repeated. Neither is better in the abstract — the choice depends on the size and position of the tumour, on how much healthy liver would have to be removed, and on whether the patient can tolerate a major operation.

Radiofrequency ablation for chronic pain

Radiofrequency ablation is also used in pain medicine, to interrupt nerves that carry pain from the spine and other joints. That is a different procedure, done by pain specialists, and it is not performed at this centre. This page is about ablation of liver tumours.

Questions worth asking

  • Why ablation rather than resection for this particular tumour?
  • Percutaneous or during an operation, and why?
  • When is the first scan, and what would make a second ablation necessary?
  • What happens to the surveillance schedule afterwards?
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