Published online May 18, 2015. doi: 10.4254/wjh.v7.i8.1054
Peer-review started: August 30, 2014
First decision: September 28, 2014
Revised: October 22, 2014
Accepted: February 9, 2015
Article in press: February 11, 2015
Published online: May 18, 2015
Hepatocellular cancer ranks fifth among cancers and is related to chronic viral hepatitis, alcohol abuse, steatohepatitis and liver autoimmunity. Surgical resection and orthotopic liver transplantation have curative potential, but fewer than 20% of patients are suitable candidates. Interventional treatments are offered to the vast majority of patients. Radiofrequency (RFA) and microwave ablation (MWA) are among the therapeutic modalities, with similar indications which include the presence of up to three lesions, smaller than 3 cm in size, and the absence of extrahepatic disease. The therapeutic effect of both methods relies on thermal injury, but MWA uses an electromagnetic field as opposed to electrical current used in RFA. Unlike MWA, the effect of RFA is partially limited by the heat-sink effect and increased impedance of the ablated tissue. Compared with RFA, MWA attains a more predictable ablation zone, permits simultaneous treatment of multiple lesions, and achieves larger coagulation volumes in a shorter procedural time. Major complications of both methods are comparable and infrequent (approximately 2%-3%), and they include haemorrhage, infection/abscess, visceral organ injury, liver failure, and pneumothorax. RFA may incur the additional complication of skin burns. Nevertheless, there is no compelling evidence for differences in clinical outcomes, including local recurrence rates and survival.
Core tip: Hepatocellular carcinoma (HCC) is a common neoplasia with high morbidity and mortality. Nowadays, technologic progress has led to several diagnostic and therapeutic challenges regarding HCC, including the optimal use of percutaneous ablation methods, defining their indications and assessing the survival impact. Both radiofrequency and microwave ablation are widely used with their respective advantages and may both offer palliation or cure in the context of a multifaceted treatment approach.