Value of radiofrequency ablation in the treatment of hepatocellular carcinoma

Abstract

Hepatocellular carcinoma (HCC) is a malignant disease that substantially affects public health worldwide. It is especially prevalent in east Asia and sub-Saharan Africa, where the main etiology is the endemic status of chronic hepatitis B. Effective treatments with curative intent for early HCC include liver transplantation, liver resection (LR), and radiofrequency ablation (RFA). RFA has become the most widely used local thermal ablation method in recent years because of its technical ease, safety, satisfactory local tumor control, and minimally invasive nature. This technique has also emerged as an important treatment strategy for HCC in recent years. RFA, liver transplantation, and hepatectomy can be complementary to one another in the treatment of HCC, and the outcome benefits have been demonstrated by numerous clinical studies. As a pretransplantation bridge therapy, RFA extends the average waiting time without increasing the risk of dropout or death. In contrast to LR, RFA causes almost no intra-abdominal adhesion, thus producing favorable conditions for subsequent liver transplantation. Many studies have demonstrated mutual interactions between RFA and hepatectomy, effectively expanding the operative indications for patients with HCC and enhancing the efficacy of these approaches. However, treated tumor tissue remains within the body after RFA, and residual tumors or satellite nodules can limit the effectiveness of this treatment. Therefore, future research should focus on this issue.

Keywords: Hepatectomy; Hepatitis B; Hepatocellular carcinoma; Liver transplantation; Radiofrequency ablation.

Figure 1

Radiofrequency ablation combined with right hemihepatectomy for multifocal hepatocellular carcinoma in a 69-year-old woman. A: Preoperative contrast-enhanced transverse helical computed tomography (CT) scan obtained during the venous phase shows one small hepatocellular carcinoma (HCC) 1.4 cm diameter in the left hepatic lobe (black arrow); B: An HCC 7.0 cm in diameter (black arrow) is present in the right hepatic lobe; C: Contrast-enhanced CT showed round ablation zones (white arrow) 6 mo after resection of the large tumor and concurrent radiofrequency ablation for the small tumor. Tumor recurrence was not found in the remnant liver.

Figure 2

Classic operative technique using a bipolar radiofrequency device for hepatectomy (A-F).