Most of these patients had undergone RFA of large lesions, and in all cases RFA had been performed using the early generation probes and generators. Our experience indicates that the rates of recurrence and complications following RFA are not negligible but can be minimized. Patients with liver malignancies, except those with neuroendocrine tumors, should be approached with curative intent and the goal of extending survival. Intraoperative ultrasound during celiotomy or laparoscopy can demonstrate intrahepatic disease not evident on spiral CT scans. We preferentially use operative ablative procedures when possible.
Operative approaches allow detection of extrahepatic disease missed by preprocedure imaging.
A laparoscopic approach provides a minimally invasive technique of ablating smaller numbers of smaller lesions. The celiotomy approach, on the other hand, is the most invasive but most versatile approach. We, therefore, recommend celiotomy or laparoscopy approaches in patients who are operative candidates and a percutaneous approach only for patients who would not tolerate operation or who have recurrent or progressive disease. To avoid injury to adjacent structures, lesions approached percutaneously must not be located peripherally in the liver. Elias and colleagues 6 have also reported the use of RFA in conjunction with other modalities.