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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:
- The management
of lumbar or low back
arthritis pain by ablating nerve tissue to reduce
pain
signals - Destruction of areas of the heart that cause
abnormal heart rhythms
(arrhythmias) - Treatment of
varicose veins - Destruction of tumors in other
sites of the body, including the
esophagus, kidney, lung, and prostate.
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
Read more about the signs and symptoms »
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 you 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.