What are the possible complications of 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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The incidence of other complications is lower than 5%. Possible complications include the following:

  • Shoulder pain
  • Cholecystitis (normally subsides after few weeks)
  • Damage to the bile ducts, resulting in biliary obstruction
  • Damage to the bowel
  • Bleeding
  • Capsular hematoma
  • Hemoperitoneum
  • Hemothorax/hydrothorax
  • Pleural effusion
  • Intraperitoneal bleeding or ascites
  • Hemobilia
  • Infection and portal thrombosis
  • Liver abscess
  • Needle-tract seeding - This is recognized as a long-term complication of RFA; it occurs mainly in lesions close to the surface or capsule of the liver
  • Collateral damage to proximal vital organs - The predictable nature of RFA generally prevents this complication
  • Self-limiting subcutaneous cellulitis

Livraghi et al found the incidence of major complications (eg, peritoneal hemorrhage, neoplastic seeding, intrahepatic abscesses, and intestinal perforation) to be 2.2% in 3554 treated lesions. [47] The incidence of minor complications was 5%, and the mortality was 0.3%. [47] Giorgio et al reported a study of 375 ablation sessions; major complications were seen in 0.9% of patients. [49] In this study, the mortality was also reported as 0.3%. [49]

Studies have shown that life-threatening acute liver failure can be considered a rare possible complication of RFA. Postablation survival depends upon Child classification, tumor multiplicity, and etiology of the HCC. Studies show that patients with HCCs that developed after viral cirrhosis had a worse prognosis than those with HCCs that occurred after alcoholic cirrhosis. [50]

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