Colorectal Cancer: In Treatment: Liver Directed Treatments
Ablative Therapies: Radiofrequency Ablation (RFA);Cryosurgery; Microwave Ablation
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A variety of ablative therapies are available including Radiofrequency Ablation (RFA), Cyrotherapy and Microwave Ablation (MA). These procedures are performed by a surgeon or interventional radiologists (IR) who specialize in oncology procedures.
All of these techniques are applicable to patients who have a limited number of metastatic liver tumors.
RFA, Cyrotherapy and MA are considered to be beneficial for patients with unresectable liver-only disease who present with tumors less than or which equal to 3-4 cm.
RADIOFREQUENCY ABLATION (RFA)
Radiofrequency Ablation uses electrical energy to create heat in a tumor for a specific period of time. The result of this "super heating" is the death or destruction of the tumor.
The procedure can be performed percutaneously by inserting a needle through the skin under x-ray guidance, then placing a probe through the needle and positioning it in the liver tumor. The percutaneious procedure is usually performed by an interventional radiologist under local anesthesia.
Alternatively, the procedure can be performed by a surgeon as follows:
- Laparoscopically, using a laparoscope that is inserted through a tiny incision in the abdomen. The doctor can examine the inside of the abdomen through the laparascope.
- Through an open surgical procedure.
RFA is safe, well tolerated and an effective treatment for patients with inoperable metastatic liver tumors. RFA is most effective in liver lesions that are less than or equal to 3-4 cm in size.
Side effects: Many patients experience a low grade fever for a few days following the RFA procedure. There is a very low risk of infection, bleeding and skin burn.
Recovery:
- If the percutaneous method is used then the patient will go home the same day.
- If a laparoscopic procedure is selected then the patient usually goes home the following day.
- An open surgical procedure requires that an incision be made in the abdomen, general anaesthesia is needed and the recovery period will be longer.
CYROTHERAPY (CYROSURGERY, CYROSURGICAL ABLATION)
Cryotherapy or Cryosurgery uses super cooled liquid nitrogen or liquid argon gas to freeze liver lesions thereby destroying the tumor . Similar to RFA, the procedure can be performed percutaneously . In cryotherapy the doctor uses MRI or ultrasound to guide the probe and monitor the formation of an “ice ball” in the tumor and limiting damage to surrounding tissue. The procedure may also be performed by a surgeon using an open surgical procedure . Clinical and laboratory research suggest that hepatic cryotherapy is effective in patients with inoperable tumors, which are located in a difficult section of the liver (near large vessels). Like RFA, cryotherapy is most effective in liver lesions that are less than or equal to 3-4 centimetres in size.
Side Effects: Complications of cryotherapy may include bleeding, mild fever, increase in liver enzymes due to damage to the bile ducts, infection or abscess.
Recovery: If the percutaneous method is used, the patient will usually go home the same day. An open surgical procedure requires that an incision be made in the abdomen, general anaesthesia is needed and the recovery period will be longer.
MICROWAVE ABLATION (MA)
Microwave Ablation (MA) is an ablative therapy that produces coagulation of soft tissue during apercutaneous , laparoscopic or open surgical procedure . Microwave ablation (MA) uses microwave energy and an antenna to cause coagulation of tissue by creating heat by friction and vibration of water molecules in the cells. The advantage of MA over other heating systems, such as RFA, is that the microwave technique is quicker and does not cause collateral damage and can be completed in 10 minutes.
Side Effects: Many patients experience a low grade fever and pain for a few days following the procedure. Major complications include liver abscess , bile duct injury, infections, bleeding and skin burn.
Recovery: If the percutaneous method is used the patient will usually go home the same day. If a laparoscopic procedure is selected then the patient often goes home the following day. An open surgical procedure requires that an incision be made in the abdomen, general anaesthesia is used, and the recovery time will be longer.
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