Current status and future of radiofrequency ablation for hepatocellular carcinoma

Radiofrequency ablation, one of the most common locoregional therapies for unresectable hepatocellular carcinoma (HCC) in Korea, has become an excellent alternative to curative surgery with advantages of minimal invasiveness, favorable complications, and low morbidity. The therapeutic efficacy of radiofrequency ablation (RFA) has been shown to be comparable to that of surgical resection for early-stage HCC. Long-term outcomes for HCC after radiofrequency ablation reported in large series studies were an overall survival of 54 - 60.2% at 5 years and 27.3 - 33% at 10 years. Recent technical developments in radiofrequency ablation include more effective separable clustered electrodes, hydrodissection techniques such as artificial ascites or pleural effusion, ultrasound - magnetic resonanace image fusion guidance, Sonazoid-enhanced ultrasonography guidance, and combined therapy with transarterial chemoembolization and sorafenib. In summary, radiofrequency ablation plays a key role in nonsurgical therapy and multidisciplinary approaches that aim to increase the survival rate of patients of hepatocellular carcinoma.

Hepatobiliary Interventions

Hepatobiliary interventional procedures are most important and commonly practiced procedures in Korea. These procedures comprise about 60~80% of procedures in interventional radiology. We can do percutaneous transhepatic biliary drainage(PTBD), percutaneous cholecystostomy in patients with bile duct and cystic duct obstruction. These procedures prevent high-risk operation and are performed on an emergency basis in some patients with bile infection. A residual biliary stone after operation can be removed with basket and shock wave without reoperation and multiple intrahepatic stones also can be removed through the PTBD tract without operation. Transarterial chemoembolization is a very effective method and has the widest range of indications in treatment of hepatocellular carcinoma(HCC). Also we can treat HCC percutaneously with local injection of absolute ethanol and radiofrequency ablation. Transjugular intrahepatic portosystemic shunt(TIPS) has replaced surgical shunt operation in variceal bleeding in liver cirrhosis. Resection of a large volume of liver is a very safe method after portal vein embolization of a lobe to be resected due to hypertrophy of the remaining lobes of the liver. Metallic stenting of kinking vessels always shows excellent results and we can employ this technique for hepatic vein and portal vein kinking after living-donor liver transplantation.