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July 2003

Percutaneous Ablation of Liver Tumors

Arch Surg. 2003;138(7):809. doi:10.1001/archsurg.138.7.809-a

Having read the interesting and topical article by Adam et al1 in the December 2002 issue of the ARCHIVES, I would like to make 2 comments.

First, there appears to be still some debate in Europe as to the relative merits of cryoablation vs radiofrequency ablation. However, due to the lower complication rate (3.3%), particularly of pleural effusion and bleeding, associated with radiofrequency ablation in one major study involving 146 patients, most North American clinicians have moved to almost exclusive use of this modality.2 This complication rate is considerably lower than the 24% quoted in the review by Adam et al, which included only 64 patients. Although this low complication rate was reported in the operative setting, the significantly smaller (ie, 1.9-mm) size of the radiofrequency probes can only facilitate their use in the percutaneous setting. In addition, the versatility of the radiofrequency device allows for multiple passes at different levels of the tumor, thus allowing full ablation of most tumors. Moreover, with the advent of the new 200-W models, tumors can now be heated at much faster rates. Based on this, we have abandoned cryotherapy in place of the more efficient radiofrequency ablation, both via the operative and percutaneous routes.