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Published online before print December 20, 2002, 10.1148/radiol.2262012198
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(Radiology 2003;226:441-451.)
© RSNA, 2003

Vascular and Interventional Radiology

Treatment of Focal Liver Tumors with Percutaneous Radio-frequency Ablation: Complications Encountered in a Multicenter Study1

Tito Livraghi, MD, Luigi Solbiati, MD, M. Franca Meloni, MD, G. Scott Gazelle, MD, PhD, MPH, Elkan F. Halpern, PhD and S. Nahum Goldberg, MD

1 From the Department of Radiology, Ospedale Civile, Vimercate, Italy (T.L., M.F.M.); Department of Ultrasound and Intervention, Ospedale Generale, Busto Arsizio, Italy (L.S.); Decision Analysis and Technology Assessment Group, Department of Radiology, Massachusetts General Hospital, Boston, (G.S.G., E.F.H.); and Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215 (S.N.G.). A complete list of participating centers of the Collaborative Italian Group Using Cool-tip Radiofrequency is included at the end of this article. From the 2000 RSNA scientific assembly. Received January 25, 2002; revision requested March 20; final revision received September 19; accepted October 1. Supported in part by Hospital Service, Milan, Italy. S.N.G. supported by Radionics. Address correspondence to S.N.G. (e-mail: sgoldber@caregroup.harvard.edu).

PURPOSE: To report complications encountered by members of a collaborative group who performed radio-frequency (RF) ablation in patients with focal liver cancer.

MATERIALS AND METHODS: Members of 41 Italian centers that were part of a collaborative group used a percutaneous internally cooled RF ablation technique and a standardized protocol for follow-up. They completed a questionnaire regarding number of deaths, presumed cause of death, and likelihood of its relationship to the RF procedure; number and types of major complications; and types of minor complications and side effects. Enrollment included 2,320 patients with 3,554 lesions (size, 3.1 cm ± 1.1 [SD] in diameter): 1,610 had hepatocellular carcinoma with chronic liver disease; 693 had metastases, predominantly from colorectal cancer (n = 501); and 17 had cholangiocellular carcinoma. Number and characteristics of complications (ie, deaths and major and minor complications) attributed to the procedure were reported. Data were subsequently analyzed with analysis of variance to determine whether the major complication rate was related to tumor size, number of ablation sessions, or electrode type (single or cluster).

RESULTS: In total, 3,554 lesions were treated. Six deaths (0.3%) were noted, including two caused by multiorgan failure following intestinal perforation; one case each of septic shock following Staphylococcus aureus-caused peritonitis, massive hemorrhage following tumor rupture, liver failure following stenosis of right bile duct; and one case of sudden death of unknown cause 3 days after the procedure. Fifty (2.2%) patients had additional major complications. The most frequent of these were peritoneal hemorrhage, neoplastic seeding, intrahepatic abscesses, and intestinal perforation. An increased number of RF sessions were related to a higher rate of major complications (P < .01), whereas the number of complications was not significantly different when tumor size or electrode type were compared. Minor complications were observed in less than 5% of patients.

CONCLUSION: Results of this study confirm that RF ablation is a relatively low-risk procedure for the treatment of focal liver tumors.

© RSNA, 2003

Index terms: Liver neoplasms, CT, 761.1211 • Liver neoplasms, MR, 761.1214 • Liver neoplasms, therapy, 761.12168, 761.32, 761.33 • Liver neoplasms, US, 761.1298 • Radiofrequency (RF) ablation




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S. N. Goldberg, C. J. Grassi, J. F. Cardella, J. W. Charboneau, G. D. Dodd II, D. E. Dupuy, D. Gervais, A. R. Gillams, R. A. Kane, F. T. Lee Jr, et al.
Image-guided Tumor Ablation: Standardization of Terminology and Reporting Criteria
Radiology, June 1, 2005; 235(3): 728 - 739.
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 GutHome page
N Sasahira, M Tada, H Yoshida, R Tateishi, S Shiina, K Hirano, H Isayama, N Toda, Y Komatsu, T Kawabe, et al.
Extrahepatic biliary obstruction after percutaneous tumour ablation for hepatocellular carcinoma: aetiology and successful treatment with endoscopic papillary balloon dilatation
Gut, May 1, 2005; 54(5): 698 - 702.
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C. Horkan, K. Dalal, J. A. Coderre, J. L. Kiger, D. E. Dupuy, S. Signoretti, E. F. Halpern, and S. N. Goldberg
Reduced Tumor Growth with Combined Radiofrequency Ablation and Radiation Therapy in a Rat Breast Tumor Model
Radiology, April 1, 2005; 235(1): 81 - 88.
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R. Lencioni, D. Cioni, L. Crocetti, C. Franchini, C. D. Pina, J. Lera, and C. Bartolozzi
Early-Stage Hepatocellular Carcinoma in Patients with Cirrhosis: Long-term Results of Percutaneous Image-guided Radiofrequency Ablation
Radiology, March 1, 2005; 234(3): 961 - 967.
[Abstract] [Full Text] [PDF]

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 Am. J. Roentgenol.Home page
L. Frich, B. Edwin, K. Brabrand, A. R. Rosseland, T. Mala, O. Mathisen, and I. Gladhaug
Gastric Perforation After Percutaneous Radiofrequency Ablation of a Colorectal Liver Metastasis in a Patient with Adhesions in the Peritoneal Cavity
Am. J. Roentgenol., March 1, 2005; 184(3_supp): S120 - S122.
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P. R. Morrison, E. vanSonnenberg, S. Shankar, J. Godleski, S. G. Silverman, K. Tuncali, M. T. Jaklitsch, and F. A. Jolesz
Radiofrequency Ablation of Thoracic Lesions: Part 1, Experiments in the Normal Porcine Thorax
Am. J. Roentgenol., February 1, 2005; 184(2): 375 - 380.
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Y. Shiratori, Y. Ito, O. Yokosuka, F. Imazeki, R. Nakata, N. Tanaka, Y. Arakawa, E. Hashimoto, K. Hirota, H. Yoshida, et al.
Antiviral Therapy for Cirrhotic Hepatitis C: Association with Reduced Hepatocellular Carcinoma Development and Improved Survival
Ann Intern Med, January 18, 2005; 142(2): 105 - 114.
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A. Giorgio, L. Tarantino, G. de Stefano, C. Coppola, and G. Ferraioli
Complications After Percutaneous Saline-Enhanced Radiofrequency Ablation of Liver Tumors: 3-Year Experience with 336 Patients at a Single Center
Am. J. Roentgenol., January 1, 2005; 184(1): 207 - 211.
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Y.-C. Lin, J.-H. Chen, K.-W. Han, and W.-C. Shen
Ablation of Liver Tumor by Injection of Hypertonic Saline
Am. J. Roentgenol., January 1, 2005; 184(1): 212 - 219.
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G. S. Gazelle, P. M. McMahon, M. T. Beinfeld, E. F. Halpern, and M. C. Weinstein
Metastatic Colorectal Carcinoma: Cost-effectiveness of Percutaneous Radiofrequency Ablation versus That of Hepatic Resection
Radiology, December 1, 2004; 233(3): 729 - 739.
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S. H. Kim, H. K. Lim, D. Choi, W. J. Lee, S. H. Kim, M. J. Kim, S. J. Lee, and J. H. Lim
Changes in Bile Ducts after Radiofrequency Ablation of Hepatocellular Carcinoma: Frequency and Clinical Significance
Am. J. Roentgenol., December 1, 2004; 183(6): 1611 - 1617.
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D. Choi, H. K. Lim, M. J. Kim, S. H. Kim, W. J. Lee, S. H. Kim, J. H. Lim, S. W. Paik, K. C. Koh, and B. C. Yoo
Therapeutic Efficacy and Safety of Percutaneous Radiofrequency Ablation of Hepatocellular Carcinoma Abutting the Gastrointestinal Tract
Am. J. Roentgenol., November 1, 2004; 183(5): 1417 - 1424.
[Abstract] [Full Text] [PDF]

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A R Gillams
Liver ablation therapy
Br. J. Radiol., September 1, 2004; 77(921): 713 - 723.
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S. Lieberman, E. Goldin, M. Lotem, and A. I. Bloom
Irrigation of the Bile Ducts with Chilled Saline During Percutaneous Radiofrequency Ablation of a Hepatic Ocular Melanoma Metastasis
Am. J. Roentgenol., September 1, 2004; 183(3): 596 - 598.
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H. Rhim, G. D. Dodd III, K. N. Chintapalli, B. J. Wood, D. E. Dupuy, J. L. Hvizda, P. E. Sewell, and S. N. Goldberg
Radiofrequency Thermal Ablation of Abdominal Tumors: Lessons Learned from Complications
RadioGraphics, January 1, 2004; 24(1): 41 - 52.
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M. A. Farrell, J. W. Charboneau, M. R. Callstrom, C. C. Reading, D. E. Engen, and M. L. Blute
Paranephric Water Instillation: A Technique to Prevent Bowel Injury During Percutaneous Renal Radiofrequency Ablation
Am. J. Roentgenol., November 1, 2003; 181(5): 1315 - 1317.
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T. de Baere, O. Risse, V. Kuoch, C. Dromain, C. Sengel, T. Smayra, M. G. E. Din, C. Letoublon, and D. Elias
Adverse Events During Radiofrequency Treatment of 582 Hepatic Tumors
Am. J. Roentgenol., September 1, 2003; 181(3): 695 - 700.
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S. N. Goldberg, J. W. Charboneau, G. D. Dodd III, D. E. Dupuy, D. A. Gervais, A. R. Gillams, R. A. Kane, F. T. Lee Jr, T. Livraghi, J. P. McGahan, et al.
Image-guided Tumor Ablation: Proposal for Standardization of Terms and Reporting Criteria
Radiology, August 1, 2003; 228(2): 335 - 345.
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J. Kettenbach, W. Kostler, E. Rucklinger, B. Gustorff, M. Hupfl, F. Wolf, K. Peer, M. Weigner, J. Lammer, W. Muller, et al.
Percutaneous Saline-Enhanced Radiofrequency Ablation of Unresectable Hepatic Tumors: Initial Experience in 26 Patients
Am. J. Roentgenol., June 1, 2003; 180(6): 1537 - 1545.
[Abstract] [Full Text] [PDF]