Complications after percutaneous saline-enhanced radiofrequency ablation of liver tumors: 3-Year experience with 336 patients at a single center

OBJECTIVE. Our objective was to report the complications that occurred in a large series of patients with primary or metastatic liver tumors treated with percutaneous saline-enhanced radiofrequency ablation under sonographic guidance at a single center during 3 years of experience. SUBJECTS AND METHODS. Between September 2000 and October 2003, 336 consecutive patients (221 men and 115 women; age range, 44-78 years; mean, 67 years) with 407 malignant liver tumors were treated at our institution using radiofrequency ablation. Of these patients, 287 had hepatocellular carcinoma from cirrhosis, 47 had liver metastases (38 from colon, six from breast, two from lung, and one from cutaneous melanoma), and two had primary cholangiocarcinoma. Adverse events related to radiofrequency ablation were prospectively recorded. RESULTS. The number of sessions performed was 375 (39 patients had two sessions). The number of patients with major complications, including death, was three (0.9%). The overall mortality rate was 0.3% (1/336). One patient died because of worsening liver decompensation. Two other major complications occurred. In one patient (0.3%), liver abscess and sepsis developed and were successfully treated with percutaneous sonography-guided needle (18-gauge) aspiration and IV antibiotics. Mild posttreatment ascites occurred in one patient (0.3%). One patient showed self-limiting subcutaneous cellulitis along the electrode-needle path that healed in 2 weeks. Fever lasting 1-3 days and pain lasting 12-24 hr were observed in 141 patients (42%) and 211 patients (63%), respectively. So far, no cutaneous or abdominal wall seeding has been observed clinically or sonographically. CONCLUSION. Radiofrequency ablation of liver tumors can be considered safe. Life-threatening acute liver failure can be considered a rare possible complication.