What are the contraindications for percutaneous radiofrequency ablation (RFA) of liver tumors?

Updated: Mar 30, 2021
  • Author: Badar Bin Bilal Shafi, MBBS, MRCP, FRCR, CCT, EBIR; Chief Editor: Kurt E Roberts, MD  more...
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Contraindications for percutaneous RFA of liver tumors include the following:

  • Bile duct or major vessel invasion
  • Significant extrahepatic disease
  • Child class C cirrhosis or active infection
  • Decompensated liver disease
  • Lesions that are difficult to reach with electrodes or when electrode placement is impaired - In such cases, an open rather than percutaneous approach should be used [30] ; it should be noted, however, that RFA of liver tumors located in the caudate lobe is effective despite this segment's deep location and the proximity of the vessels [31, 32]
  • Tumors that occupy more than 40% of the volume of the liver - Tumors of this size cannot be safely ablated, because the liver reserve left after RFA might not be sufficient to preserve hepatic function
  • Proximity to vital structures like vessels and adjacent organs [33] - This is a relative contraindication; open RFA was suggested by one study [30]
  • Lesions larger than 5 cm (relative contraindication) - RFA should be used cautiously for lesions larger than 5 cm; one study suggested the use of open RFA for such lesions [30]
  • Patients with metastatic lesions larger than 3 cm - These lesions are not optimally suited for RFA, because the risk of recurrence is high [23]
  • Large or numerous tumors - Multiple studies have recommended RFA as a choice if there are fewer than three tumors, each of them measuring less than 3 cm [34, 35, 36]

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