Liver ablation - A guide for patients

Introduction

This leaflet is designed for patients who have been advised to have a liver ablation procedure as part of the treatment for liver cancer.

What is a liver ablation?

A liver ablation is a procedure where a device is inserted into a tumour within the liver, and then heat is generated to destroy the tumour tissue.

There are two main ways of generating the heat, either with radiofrequency energy (RFA) or with microwave energy (MWA).

The device is placed into the tumour through a tiny cut in the skin, and guided into place using either ultrasound or computed tomography (CT).

The whole procedure takes place under a general anaesthetic.

Why do I need a liver ablation?

Your doctor has determined that the tumour within your liver can be most suitably treated with an ablation procedure.

Who has made the decision?

All patients attending for liver ablation will have been discussed in a multi-disciplinary meeting of specialists, who have recommended liver ablation as the most suitable option for treatment.

However, you will also have the opportunity for your opinion to be taken into account. If after discussion with your doctors, you do not want the procedure carried out, you can decide against it.

What happens before the procedure?

• Please refer to the pre-assessment instructions for information prior to the general anaesthetic
• Do not eat or drink anything after midnight the night before your procedure, unless told otherwise. If you need to take medicine, take it with only a sip of water.
• Please bring in a small overnight bag to include your own washing items, sanitary wear, dressing gown and slippers.
• You will be admitted to hospital on the day of the liver ablation, usually to the day surgery unit.
• You may have a small needle put into a vein in your arm for painkillers to be given if necessary.
• Standard blood tests may be carried out.
• If you have any allergies you must let your doctor know.
• If you take any medications to thin the blood (anticoagulants or antiplatelets) please let us know beforehand, as these will need to be stopped a certain length of time before the procedure.
  • Examples include: warfarin, dalteparin, enoxaparin, tinzaparin, dabigatran, rivaroxaban, apixaban, clopidogrel, ticagrelor.
  • Low dose aspirin (75mg) is safe to continue.
  • Please discuss with a doctor before stopping any medicines, as sometimes other treatment will need to be given.
• If you have previously reacted to intravenous contrast medium (the dye used for CT scans), you must also tell your doctor about this.

Who will be performing the liver ablation?

• A specially trained doctor called an interventional radiologist will be performing your liver ablation.
• Radiologists have special expertise in using ultrasound and CT equipment and in interpreting the images produced.
• They will look at these images while carrying out the procedure.
• The radiologist will be assisted by a radiographer and nurses.

What happens during the liver ablation?

• You will be asked to change into a hospital gown.
• The procedure is performed under general anaesthetic. You will be put to sleep by an anaesthetist.
• Using either ultrasound or CT guidance the ablation device is guided into the tumour, the tumour is then burned with either microwave or radiofrequency energy.
• Sometimes the ablation device is inserted more than once, depending on the number and size of tumours being treated.
• You will then be woken up and recover from the general anaesthetic on the ward.

Will the liver ablation hurt?

• The operation is performed under general anaesthetic, so you will feel no pain during the procedure.
• Afterwards you can sometimes have discomfort on the right side, or at your right shoulder tip. Please tell a nurse so they can give you pain relief if necessary.

How long does the liver ablation take?

• Every patient’s situation is different, and it is not always easy to predict how complex or how straightforward the procedure will be.
• Generally, the procedure will last approximately one hour if performed under ultrasound guidance, and two to three hours if performed using CT.

What will happen after the liver ablation?

• You will be taken back to your ward.
• Nursing staff may carry out routine observations including taking your pulse and blood pressure and will also check the treatment site.
• If you experience pain or sickness let the nursing staff know.
• You will need to stay in bed for six hours after the liver ablation.
• You will usually need to stay in hospital overnight, unless your doctors have told you beforehand you can be discharged on the same day. Most liver ablations require an overnight stay.
• You will need someone to pick you up and take you home.
• You must not drive or use public transport to get home.
• You will need a responsible adult at home with you for the night following the procedure (important if a day-case procedure).
• After the liver ablation, you will need a follow-up scan of the liver four to six weeks later, in order to assess the response to the treatment. Further treatment may be recommended depending on the scan results.

What are the benefits?

• The purpose of the liver ablation is to destroy the tumour within the liver, without causing too much damage to the surrounding tissues. It is potentially curative for tumours that are only within the liver.
• Generally liver ablation is much safer and less damaging than open surgery, and may be suitable in situations where surgery is impossible.
• Liver ablation is sometimes combined with other treatments (including open surgery) to give you the best possible outcome.

What are the risks?

• Liver ablation is generally a safe procedure, but as with any procedure there are risks.
• Most patients will feel tired following the procedure, often with flu-like symptoms. This is known as post ablation syndrome. These symptoms should settle over one to two weeks. If you are getting worsening fevers you should contact your doctors, as it may indicate an infection within the liver.
• The liver has many blood vessels within it, and these may be injured during the ablation. However, the ablation device burns the hole in the liver as it is removed, which reduces that risk. Rarely significant bleeding or artery damage may need to be treated with an operation.
• There is a small risk of damaging the bile ducts within the liver. This rarely can cause bile to leak out around the liver, which may require other procedures.
• In situations where there is damage to the bile ducts or blood vessels, there is a rare risk of worsening the liver function. Depending on how much liver is affected, and how good your liver function was beforehand, this could be serious.
• The ablation device may injure organs around the liver, such as: lungs, bowel, gallbladder, stomach and kidneys. The exact risk of this depends on where the tumour is and will be explained by your doctor. If another organ is injured this may be serious and require further operations.
• If the tumour is difficult to target during the procedure, then it may not be accurately ablated. This may require repeat ablations on another day.
• Sometimes the tumour may be close to blood vessels that cool the tumour (heat sink), preventing the tumour heating up to destroy it. This may result in an incomplete ablation, where some tumour remains.
• If you are having a CT guided ablation, your kidney function may rarely be affected by the contrast dye injected, though this usually recovers.

Radiation (CT guided ablation)

• You have been referred for an Interventional Radiology procedure to help deliver your treatment. A specialist in radiology agrees that this is the best procedure to treat your clinical condition and that the benefit of the examination is greater than the risk.
• The x-ray involves a dose of ionising radiation equivalent to a few months or years of natural background radiation which we are all exposed to every day.
• Ionising radiation can cause cell damage that may turn cancerous however the risk of this happening from your examination is considered low.
• Depending on the length of the procedure, there may also be a small risk of an excess radiation dose to the skin. This may lead to short term and long term effects (e.g. reddening of the skin and burns).
• If this happens as a result of this procedure, you will receive further advice following the procedure. The dose delivered will be kept as low as is practicable.
• For further information please visit our Imaging-radiology page.

Conclusion

Some of your questions about adrenal venous sampling should have been answered by this leaflet, but remember this is only a starting point for discussion about your treatment with the doctors looking after you.

This document has been adapted from one prepared by the British Society of Interventional Radiology (BSIR).

Medication

Bring all of your medicines (including inhalers, injections, creams, eye drops or patches) and a current repeat prescription from your GP

Please tell the ward staff about all of the medicines you use. During your stay If you wish to take your medication yourself (self-medicate), please speak with your nurse. Pharmacists visit the wards regularly and can help with any medicine queries.

My Chart

We would encourage you to sign up for MyChart. This is the electronic patient portal at Cambridge University Hospitals that enables patients to securely access parts of their health record held within the hospital’s electronic patient record system (Epic). It is available via your home computer or mobile device

More information is available on our website: CUH - MyChart.

Contacts/further information

Angiography Department: 01223 348920