Unexplained liver hemorrhage after metastasis radiofrequency ablation

Colorectal carcinoma is one of the most common cancers in the world. Approximately one in four of these patients have metastases at diagnosis, liver being the most common site involved. Although historically it was considered that liver metastases meant a very poor prognosis, today, due to improved systemic therapy, many patients will be candidates for local hepatic treatments such as surgery or less aggressive radiofrequency ablation. Both of these procedures have resulted in improvements in global and disease-free survival. However ,a report of unexplained liver haemorrhage after metastasis radiofrequency ablation has been published on October 28, 2009 in the World Journal of Gastroenterology.

Radiofrequency ablation is increasing used in the field of oncology. Although some studies have found low rates of complications, ranging from 2.4% to 8.9%, the rate of intraperitoneal haemorrhage is low (0.46%-1.6%) but relevant because this technique is increasingly used with few selection criteria for patients. The reported reasons for haemorrhage are usually related to mechanical injuries to the liver blood vessels and occur most often in patients with cirrhosis. Other cases have been attributed to serious coughing or hiccups after the radiofrequency treatment which might cause increased abdominal pressure and tumour rupture.

Liver laceration has rarely been described as a cause of haemorrhage. This complication has been associated with inappropriate electrode positioning or mechanical injury of the soft liver during the procedure and possibly displacing the electrode slightly. Although the procedure may go well, the patient could present with this type of complication without known risk factors. This makes it absolutely essential to minimise complications associated with radiofrequency ablation treatments, and to correctly deal with complications which do arise. In all these cases it is relevant to closely observe patients after this procedure to provide early intervention to minimise the damage and severity of complications.

Reference: Uña E, Trueba J, Montes JM. Unexplained liver laceration after metastasis radiofrequency ablation. World J Gastroenterol 2009; 15(40): 5103-5105 http://www.wjgnet.com/1007-9327/15/5103.asp

Correspondence to: Esther Uña, MD, Medical Oncology Service, Clinical University Hospital of Valladolid, C/Ramon y, Cajal 3, Valladolid 47005, Spain. aunacid@hotmail.com Telephone: +34-983-420000-20561 Fax: +34-983-420080

World Journal of Gastroenterology (WJG), a leading international journal in gastroenterology and hepatology, has established a reputation for publishing first class research on esophageal cancer, gastric cancer, liver cancer, viral hepatitis, colorectal cancer, and H. pylori infection and provides a forum for both clinicians and scientists. WJG has been indexed and abstracted in Current Contents/Clinical Medicine, Science Citation Index Expanded (also known as SciSearch) and Journal Citation Reports/Science Edition, Index Medicus, MEDLINE and PubMed, Chemical Abstracts, EMBASE/Excerpta Medica, Abstracts Journals, Nature Clinical Practice Gastroenterology and Hepatology, CAB Abstracts and Global Health. ISI JCR 2008 IF: 2.081. WJG is a weekly journal published by WJG Press. The publication dates are the 7th, 14th, 21st, and 28th day of every month. WJG is supported by The National Natural Science Foundation of China, No. 30224801 and No. 30424812, and was founded with the name of China National Journal of New Gastroenterology on October 1, 1995, and renamed WJG on January 25, 1998.