Intraoperative radiofrequency ablation (RFA) for irresectable liver malignancies

Aims. To evaluate the outcome of patients who received radiofrequency ablation (RFA) at open laparotomy in patients with irresectable liver malignancies. Methods. Twenty-six consecutive patients who underwent explorative laparotomy and were found to be irresectable or who had been assessed not suitable for either resection or percutaneous RFA received intraoperative RFA. An expandable electrode (RITA Medical systems) was used. Follow-up comprised CT-scans in 6–12 week intervals. Results. Patients' age ranged from 35 to 72 years (median 61). A variety of pathologies were treated. In 26 patients, 88 hepatic lesions were treated: 32 with resection and 56 with RFA. The mean diameter was 4.0±2.6 cm with a maximum of 10 cm. In 22 patients with hepatic metastases (18 colorectal, one leiomyosarcoma, one endometrium carcinoma, one renal cell carcinoma, one malignant phaeochromocytoma) 74 lesions (median 3.4 per patient) were treated (25 by resection, 49 by RFA). Eleven patients received simultaneous resection and RFA: resection of anatomical segments in six and atypical resection in seven patients. Procedure related complication rate was 19.2%. The mean follow-up was 14.6±9.2 months (2–36 months). Three patients developed recurrence at the site of previous RFA indicating incomplete ablation. The overall local control rate after one year was 92 and 90.9% for patients with colorectal liver metastases, respectively. Seventeen patients (65.4%) suffered from tumour progress. In 14 patients (53.9%) tumour occurred at new hepatic localisations and in five patients extrahepatic tumour relapse was diagnosed. Twelve patients have died so far (median survival 18 months, range 4–27). Nineteen patients had either completed a follow-up of at least 12 months or died within this period, resulting in an one year survival rate of 79% (80% for liver metastases). Conclusion. Intraoperative RFA is a valuable tool in liver surgery which extends the surgical spectrum in cases of irresectable malignancies.