What is Radiofrequency Ablation? Many methods of minimally invasive therapy have been tried in recent years to eliminate tumors in organs such as the liver. The most successful is called radiofrequency ablation (RFA). A special needle electrode is placed into the tumor under the guidance of an imaging method such ultrasound, computed tomography (C1) scamling, or magnetic resonance imaging (MRl). Alternating current is then passed through the electrode heating the tissue around the needle tip and ablating - or eliminating - the tumor. What are some common uses of the procedure? The principle use of radiofrequency ablation is in the treatment of liver malignancies. These malignancies are primarily hepatocellular carcinoma or hepatoma, which is a primary liver cancer, colon cancer that has spread to the liver (metastases) and neuroendocrine tumor metastases (islet cell and carcinoid tumors). Other types of liver metastases are occasionally treated. RFA can also be used to treat certain primary cancers such as lung, bone and renal tumors. It can be an effective treatment option in some patients who are not candidates for surgery or have failed chemotherapy. RFA is seldom used to treat liver tumors if active cancer is present outside the liver. Complete destruction of the tumor cannot be guaranteed, however, in general, RFA is more effective with smaller tumors as larger tumors may not be completely eliminated. How should I prepare for the procedure? You will be asked to avoid food and liquids starting at midnight the evening before treatment. Your doctor will tell you which medications you may take in the morning. Aspirin should be stopped before the procedure. Consult your doctor if you are taking Coumadin or another blood thinner. You may stay in the hospital following the procedure. Most patient's are discharged the next day. How is the procedure performed? Three components are needed for radiofrequency ablation: needle electrode, electrical generator, and grounding pads. The needle elctrode comes in two forms: simple straight needle, and a hollow needle that contains multiple curved, retractable electrodes. When positioned into the tumor, the electrodes are advanced through the needle into the tumor. The radiofrequency generator is connected to the electrodes and to grounding pads that are placed on the patient's thigh. Electrical current at radiofrequency wave length passes between the needle electrode and the grounding pads placed on the patient's skin. The current creates heat round the electrode within the tumor and literally cooks the tissue, destroying it. Destroyed cells are then gradually replaced by scar tissue. Radiofrequency ablation is performed by placing the electrode directly thorough the skin (percutaneous placement), by placing the electrode through a small incision in the abdomen (laparoscopy); or during open surgery. Percutaneous RFA is performed with intravenous sedation or under general anesthesia while laparoscopic and surgical radiofrequency ablation is performed under general anesthesia. The percutaneous electrode is placed using ultrasound or computed tomography. What will I experience during the procedure? The procedure is usually completed in 1 to 3 hours depending on tumor size and number of sites treated. You will remain in the recovery room until awake and either discharged later in the day or admitted for overnight observation. Occasionally, patient's spend two to three days in the hospital management of pain or nausea. The patient may experience soreness for a few weeks following the procedure. Following ablation, an MRI or CT scan is performed in one month to evaluate extent of tumor destruction. You will then have repeat CT scans or MRI scans every 3 to 6 months. What are the risks? Bleeding is unusual but can be serious and is rarely fatal. Organs and tissue within or near the liver, such as the gallbladder, bile ducts, diaphragm, and bowel, are at risk of being injured. If this occurs, surgical correction may be necessary. Potential complications include abscess formation and skin burn, among others. Overall complications occur in 3-5% of patients.