**1. Introduction**

174 Liver Tumors

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of repeat hepatectomy for recurrent liver metastases from colorectal carcinoma.

preoperative imaging in evaluating colorectal liver metastases declines over time.

Chemotherapy-associated hepatotoxicity and surgery for colorectal liver

Hepatic resection still remains the golden standard treatment for patients with primary and metastatic liver cancer and offers the best chance for cure and survival (Agrawal & Belghiti, 2011). However the vast majority of the patients with malignant liver tumors are not suitable for hepatectomy due to number or distribution of the hepatic lesions relative to future liver remnant volume. Aiming to overcome these limitations various local tumor ablation techniques were developed. Among them radiofrequency ablation (RFA) gained popularity in the past decade and became the most used local ablation technique worldwide. The principles of RFA are well described and discussed elsewhere (Rhim et al, 2001; Ahmed & Goldberg, 2004; Chen et al, 2004). In brief - needle electrode/-s and high frequency electric current generator are used during RFA, in order to heat and coagulate neoplastic tissue (Figure 1).

Fig. 1. Schematic view of the RFA process with the LeVeen needle electrode.

A sufficient rim of healthy liver parenchyma should also be destroyed as a safety margin. The size and geometry of created ablation zone depends mainly on the ablation protocol, electrodes used, tissue impedance and proximity of large vessels. Various RFA devices and electrodes are present on the market (Pereira et al, 2004), and they should be carefully evaluated before starting a clinical RFA program. Whenever possible the RFA devices should be tested in animal laboratory in order to become more familiar with the chosen technique before its clinical application. Clinical RFA of liver tumors currently is being performed percutaneously or during operation. Intraoperative RFA can be performed either as a sole procedure or (more frequently) as an adjunct to hepatic resection in order to control the functionally unresectable disease in the remnant liver (Figure 2). This chapter will discuss the rationale and technical aspects of intraoperative RFA in the treatment of patients with liver tumors.

Fig. 2. Follow-up computed tomografy of patients after combined RFA and right hepatectomy (A) or left hepatectomy (B) for colorectal liver metastases.
