Abstract
Radiofrequency ablation (RFA) has become a common approach in the treatment of hepatocellular carcinoma in patients that are not surgical candidates. Currently, there is no consensus on the prophylactic use of antibiotics during treatment. The purpose of this retrospective chart review was to determine if routine antibiotic prophylaxis is necessary for RFA of primary liver tumors.
Over a five-year period, 64 patients with a 120 tumors designated as hepatocellular carcinoma underwent 91 percutaneous RFA procedures at a single institution using Rita RFA probes (Angiodynamics). No pre or post procedure antibiotic prophylaxis was provided during 89 procedures. Two patients received prophylaxis prior to the procedure. One of these patients had a co existing condition of septic arthritis requiring treatment. The other patient received antibiotics as per interventional radiologist’s discretion. The ablation zones ranged from 2.5 to 7 cm. The medical records of the patients who underwent the RFA procedures were reviewed retrospectively and analyzed for the frequency of infectious complications, including abscess formation. Follow up ranged from 9 months to 5 years. Minor and major complications were analyzed according to SIR guidelines.
Liver abscess developed in 1 patient after radiofrequency ablation, (1/91 [1%]). This patient had a procedure related complication after the inadvertent placement of ablation probe tines within the gall bladder. A large abscess formed which was subsequently treated with IV antibiotics and percutaneous catheter drainage. In the patients experiencing post radiofrequency ablation syndrome, symptomatic treatment was provided without the use of antibiotics. These symptoms were self-limited. In the non-complicated cases of RFA, no infectious complications developed.
The development of hepatic abscess is an infrequent complication of percutaneous radiofrequency ablations for hepatoma. Our study shows that without underlying risk factors predisposing to infection, routine antibiotic prophylaxis may be unnecessary. Vigilant post treatment follow up remains critical for early detection and management of infectious complications.