**5. References**


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

Agrawal, S. & Belghiti, J. (2011). Oncologic Resection for Malignant Tumors of the Liver.

Ahmed, M. & Goldberg, S. (2004). Radiofrequency tissue ablation: principles and

Aloia, T.; Vauthey, J.; Loyer, E. et al. (2006). Solitary colorectal liver metastasis: resection determines outcome. *Arch Surg*, Vol.141, pp. 460–466, ISSN 0004-0010 Birth, M.; Hildebrand, P.; Dahmen, G. et al. (2004). Present state of radio frequency ablation of liver tumors in Germany. *Chirurg*, Vol.75, pp. 417–423, ISSN 0009-4722 De Baere, T.; Bessoud, B.; Dromain, C. et al. (2002). Percutaneous Radiofrequency Ablation

Chen, M.; Yang, W.; Yan, K. et al. (2004). Large Liver Tumors: Protocol for Radiofrequency

Elias, D.; Azzedine, E.; Alain, G. et al. (2001). Intraductal cooling of the main bile ducts

Elias, D.; Sideris, L.; Pocard, M. et al. (2005). Incidence of unsuspected and treatable

techniques. In: *Radiofrequency ablation for cancer: current indications, techniques and outcomes*, L. Ellis, S. Curley & K. Tanabe, (Eds.), Springer-Verlag, ISBN 978-1-4419-

of Hepatic Tumors During Temporary Venous Occlusion. *AJR*, Vol.178, pp. 53–59,

Ablation and Its Clinical Application in 110 Patients—Mathematic Model, Overlapping Mode, and Electrode Placement Process. *Radiology*, Vol.232, pp. 260–

during intraoperative radiofrequency ablation. *J Surg Oncol*, Vol.76, pp.297-300,

metastatic disease associated with operable colorectal liver metastases discovered only at laparotomy (and not treated when performing percutaneous radiofrequency ablation). *Ann Surg Oncol*, Vol.12, pp. 298–302, ISSN 1068-9265

*Ann Surg*, Vol.253, pp. 656–665, ISSN 0003-4932

3058-3, New York, USA

ISSN 0361-803X

271, ISSN 0033-8419

ISSN 1096-9098

liver surgeon.

**5. References** 

