**4. Conclusions**

The two crucial questions must be always addressed when considering RFA as a treatment option in a patient with primary or metastatic liver cancer: 1. Whether RFA is equal in curability to surgical resection for resectable malignant liver tumor, and 2. What additional survival benefit does RFA has over modern systemic therapies in the treatment of unresectable disease? The long-term results from clinical studies to date showed significantly better survival obtained from surgical resection for all types of resectable malignant liver tumors. Thus RFA cannot be regarded as an equally effective alternative of liver resection. On the other hand, if compared with systemic treatment alone there is enough clinical data to demonstrate that when local control is achieved by RFA it offers survival advantage (and even cure) for patients with unresectable disease. Unfortunately these facts are frequently misinterpreted and lead to misuse or abuse with RFA. In a survey from Germany 25.9% of patients undergoing RFA had a resectable tumor (Birth et al, 2004). This is partly because of the public pressure on physicians to refer their patients for minimally invasive treatment, rather than for major surgery, becomes heavier today. As a consequence many radiologists and gastroenterologists start to treat with percutaneous RFA patients with resectable tumors. On the other hand, surgeons that have no experience with hepatic surgery start to perform RFA as an alternative to resection in resectable cases, rather than referring these patients to the experienced liver surgeon. As the philosopher Abraham Maslow once said, "If the only tool you have is a hammer, then you tend to see every problem as a nail." However, when RFA is properly used in patients with primary and metastatic liver cancer its clinical benefits in terms of prolonged survival and even cure are indisputed. Today the RFA-device clearly is a necessary tool in the armamentarium of a liver surgeon.
