Complications of intraoperative radiofrequency ablation of liver metastases

Abstract

Background

Intraoperative radiofrequency ablation (IRFA) of liver metastases can be used to treat patients with complex tumours that are unsuitable for parenchymal resection alone. This systematic review assesses the frequency, patterns and severity of complications associated with this procedure.

Methods

We carried out a bibliographic search on MEDLINE focused on IRFA for liver metastases, excluding hepatocarcinomas, and on intraoperative use, excluding percutaneous application.

Results

Thirty papers published between 1999 and 2007 were analysed. They covered a total of 2822 patients and 1755 IRFA procedures. The indications and techniques for IRFA differ from those for percutaneous treatment, as do associated results and complications. Specific complications associated with IRFA, such as liver abscesses, biliary stenoses and vascular thromboses, are directly correlated with the indications and associated procedures. Published results should be interpreted with caution as IRFA can be used alone or combined with parenchymal resection.

Conclusions

Specific complications related to IRFA are rare, especially for lesions of <35 mm in size located far from a main biliary duct, when additional septic procedures are not used. A lesion-by-lesion approach based on the benefit : risk ratio should therefore be used in the process of making surgical decisions. Combining resection with IRFA leads to higher morbidity, especially in difficult patients with numerous bilateral lesions, but may be necessary to achieve R0 (microscopically negative margins) outcomes.