Oncology Wavelengths

Little Company of Mary – San Pedro Hospital’s full-time surgical oncology physician, Moshe Faynsod, MD, discusses the relatively new technique of radiofrequency ablation (RFA), used to treat patients with liver tumors.

 
What is radiofrequency ablation and what types of patients benefit from it?

Moshe Faynsod: It’s a relatively new technology — a technique for treating both primary and metastatic tumors in the liver. You wouldn’t offer RFA to a patient who is a candidate for a resection, which is still the gold standard. RFA is for patients who can’t tolerate resection or when resection is otherwise not feasible. Resection is one of the biggest operations that patients can undergo. You have to really pick your patients and be clear about what the expectations are.

 
How does RFA actually work?

MF: This device is hooked up to a specialized generator and saline pump. Under ultrasound, the probe is inserted into the liver and then we release these little needle-like extensions into the tumor. The depth depends on the size of the ablation we need to perform. An alternating current is applied to the ends of the probe, causing the electrons in the tissue to vibrate. The needles infuse saline into the tissue. The saline keeps the tissue moist, so there are enough electrons to conduct the electricity. As the electrons vibrate, the resulting friction, not the probe itself, heats the tissue. We heat the tissue to 90 degrees while cell death occurs at about 50 degrees. Another advantage is that more normal liver is preserved because little damage occurs beyond the margins of ablation.

This other probe is very new. It ablates tissue as well, but it’s used for resections. Its effect is limited to a square centimeter so you have to use it repeatedly through the plane you’re going to cut. The liver is very vascular. But after the probe is inserted, you hit a foot switch, and within a few seconds it cauterizes all the tissue contained within the probe limits. So you do this where you need to cut then you get very little bleeding.

Is the lack of blood loss a specific advantage to this process?

MF: Surgeons seeing this for the first time on video say, “There’s no way that’s real.” If you were to cut a normal liver without using this probe first, blood would be pouring out. You wouldn’t even be able to see where it was coming from unless you stop blood flow to the entire liver. That itself has risks for complications. With this probe, you reduce the amount of bleeding and the need for transfusions, which is clearly an advantage over conventional techniques.   Continue »

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