Radio Frequency Ablation Liver Cancer Treatment at World Class Hospitals in India

Radiofrequency ablation (RFA) is a new technique used to treat benign and malignant liver tumors, often without the long incisions traditionally used in liver tumor ablation.

In the past, destruction of liver tumors could only be accomplished by freezing (cryoablation) or injection with toxic chemicals. RFA combines the advantages of improved technology and minimally invasive surgery to give patients another option for treatment of liver tumors.

At California Pacific Medical Center, we have incorporated radiofrequency ablation into our treatment for hepatocellular carcinoma (liver cancer) as well as other cancers that have spread to the liver, such as metastatic colon cancer.

How Does RFA Work?

Radiofrequency ablation uses alternating current (electricity) delivered through a specially designed probe that is directed into the liver tumor using ultrasound or CT scan guidance. The probe allows the electric current to pass into the tumor, while the surrounding tissues (skin, muscle and blood vessels) are not affected. The electric current generates heat which causes death of tumor cells. After the tumor cells are destroyed, the tumor will eventually be replaced by scar tissue.

Related Procedures

Depending on your situation, your doctor may talk with you about other pancreatic operations. Seek a second opinion from a specialized surgeon if needed. Options include:

How is RFA Performed?

Radiofrequency ablation can be performed using many different approaches, but usually requires surgery and general anesthesia to be done safely. In most cases laparoscopic surgery is used, employing small incisions with a camera placed inside the abdomen to guide the ablation procedure.

Typically three or four small incisions are made. Ports are then inserted into these incisions, which enable the surgeon to easily guide the radiofrequency and ultrasound probes into the liver (see illustration on reverse). The location of each incision depends upon the location of the tumor within the liver. In rare situations, the tumor may be too large for the laparoscopic approach, or may be located in an area that is not safe for laparoscopic surgery. In these cases, a traditional open incision will be used.

During surgery, a small ultrasound probe is also placed into the abdomen to accurately locate the tumor and guide the RFA probe into the center of the tumor. Patients typically spend four hours in surgery.

What happens before Treatment?

The doctor who will perform the procedure reviews your medical history and previous imaging studies to plan the best location for the ablation. Be prepared to ask any questions you may have at this appointment.

Patients who are take aspirin or a blood thinning medication may need to stop taking it several days before the procedure. Discuss any medications with your doctors, including the one who prescribed the medication and the doctor who will perform the injection.

The procedure is usually performed in an outpatient special procedure suite that has access to fluoroscopy. Make arrangements to have someone drive you to and from the office or outpatient center the day of the ablation.

Types of RFA Procedures

The approaches to RFA include one of the following:

• Percutaneous (through the skin without an operation).
• Laparoscopic (several small incisions).
• Open RFA (an abdominal incision), if minimally invasive surgery is not appropriate.

In some cases, superficial tumors can be wedged out (excised), while deeper lesions can be destroyed by RFA, thereby preserving most of the liver tissue.

The team at the Liver Cancer Center decides which approach is best for you, based on the number and location of the tumors in the liver.

For a large tumor, it may be necessary to do multiple ablations by repositioning the needle electrode into different parts of the tumor to ensure no tumor tissue is left behind. At the end of the procedure, the needle electrode will be removed and pressure will be applied to stop any bleeding and the opening in the skin is covered with a dressing. No sutures are needed. Each radiofrequency ablation takes about 10 to 30 minutes, with additional time required if multiple ablations are performed. The entire procedure is usually completed within one to three hours.

At the time of the procedure, you will be asked to sign consent forms, list medications you are presently taking, and if you have any allergies to medication. The brief procedure may last 15-45 minutes, followed by a recovery period.

The patient lies on an x-ray table. Local anesthetic is used to numb the treatment area. The patient experiences minimal discomfort throughout the procedure. The patient remains awake and aware during the procedure to provide feedback to the physician. A low dose sedative, such as Valium or Versed, is usually the only medication given for this procedure.

The technique for nerve ablation is similar to that used for diagnostic blocks. With the aid of a fluoroscope (a special x-ray), the doctor directs a thin hollow needle into the region responsible for the pain. Fluoroscopy allows the doctor to watch the needle in real-time on the fluoroscope monitor to make sure that the needle goes to the desired location. Contrast may be injected to confirm correct needle location. Some discomfort occurs, but patients typically feel more pressure than pain.

Benefits of RFA

Proven Technology:

• RFA technology has been used in thousands of people in the United States and Europe.
• Since the RFA program at UPMC began in 1999, hundreds of patients have received this form of therapy at the Liver Cancer Center.

Minimally Invasive:

• A major advantage of RFA is that the procedure can often be done using minimally invasive surgery.

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