Liver Cancer RFA: Procedure Steps and Recovery Time (US, UK, Japan)

Radiofrequency ablation (RFA) for liver cancer is a procedure in which a thin needle is passed through the skin into a liver tumour and the cancer is destroyed with heat. Comparing official patient guides from the US, the UK and Japan, the procedure itself takes about 1–3 hours, the hospital stay ranges from same-day discharge to 1–2 days, and symptoms such as fever and tiredness usually settle within 1–2 weeks.

However, the type of anaesthesia and the length of stay differ quite a lot between countries and hospitals. This article brings together, in one place, the tests before treatment, what happens on the day, the recovery timeline and complication rates that patients with hepatocellular carcinoma of 3 cm or less and no more than three tumours, and their families, should know before consulting a hospital abroad.

What is RFA for liver cancer?

In RFA, the doctor watches the tumour on ultrasound or CT, inserts an electrode needle through the skin of the abdomen into the centre of the tumour, and uses high-frequency electrical current at the needle tip to heat and kill the cancer cells. The aim is to destroy not only the tumour but also a small rim of normal liver around it, to reduce the chance of cancer cells being left behind. Because there is no open surgery and only a needle mark remains, it is one of the main local treatments in interventional radiology (IVR).

The Cancer Information Service of the National Cancer Center Japan describes the actual heating time as about 10–30 minutes per session. If there are several tumours or a larger tumour, the needle is repositioned several times and the whole procedure takes longer. Microwave ablation (MWA), which uses microwaves on the same principle, is also widely used, and from the patient's point of view the process and recovery are almost the same. The basic principle of RFA is explained on our RFA guide.

Who is it for?

Japan's Cancer Information Service states that RFA is performed when liver function is Child-Pugh class A or B and there are no more than three tumours, each 3 cm or smaller. Patient material from IASIOS, the interventional oncology accreditation system run by the Cardiovascular and Interventional Radiological Society of Europe (CIRSE), is similar: ablation is used with the goal of cure for small tumours up to 3 cm, and can be used for tumours up to 5 cm when surgery is not possible.

If tumours are larger or more numerous, other IVR treatments such as chemoembolisation (TACE), surgery or drug therapy are considered first. For tumours right next to large blood vessels, bile ducts, the bowel or the diaphragm, heat can be carried away or nearby organs can be injured, so the needle angle may be changed or a different method chosen. Results of a phase 3 trial combining TACE and RFA for intermediate-stage liver cancer are covered in our article on the TORCH trial of TACE plus RFA.

Tests and preparation before RFA

Before treatment is decided, contrast CT or MRI is usually used to check the size, number and location of tumours, and blood tests check liver function, blood clotting and kidney function. According to UW Medicine (University of Washington), most patients need blood tests, which may be done on the day of the procedure. At hospitals that use general anaesthesia, patients meet an anaesthesia provider first.

• Fasting: both the US and UK hospital guides say not to eat or drink from midnight the night before. Medicines you must take can be taken with a sip of water, but do not take any medicine the team told you to stop.
• Blood thinners: drugs such as warfarin or clopidogrel may need to be stopped in advance. The UW Medicine guide says 3–9 days before depending on the drug, and the Cambridge University Hospitals (CUH) guide says low-dose aspirin (75 mg) can be continued. In every case, do not stop on your own; talk to the doctor who prescribed it.
• Supplements and vitamins: the UW Medicine guide says not to take them on the day.
• Companion: both the US and UK guides advise that an adult must drive you home on the day of discharge and stay with you the first night.

What happens on the day

On arrival you change into a gown and a drip (IV line) is placed in your arm. Many hospitals give antibiotics before the procedure to reduce infection risk. The procedure is done by an interventional radiologist in an ultrasound or CT room; the skin where the needle will go is cleaned, and the electrode is guided in under imaging. Several tumours can sometimes be treated in one session.

Procedure times are described slightly differently. Cambridge University Hospitals says about one hour with ultrasound guidance or two to three hours with CT, and UW Medicine says 1–3 hours depending on tumour size and number. Afterwards the needle is removed and only a small dressing is applied; the only visible mark is a needle mark about a quarter of an inch (about 0.6 cm). Imaging right after the procedure checks whether the tumour has been fully treated.

Recovery timeline

Putting the guidance from several organisations in time order gives the table below. Figures are taken as written in each source; because standards differ between organisations, ranges are shown.

Hospital stay and activity limits vary by hospital, country and patient condition. One guide advises avoiding baths and swimming until the needle site has fully healed (UW Medicine).

If the first scan shows remaining tumour, the procedure may be repeated or another treatment added. Even after that, new tumours can appear elsewhere in the liver, so regular scans and blood tests continue.

Side effects and complication rates

The most common problem is pain. IASIOS patient material says up to about half of patients feel mild to moderate pain that is controlled with medicine. The UK guide also notes that discomfort on the right side or at the tip of the right shoulder can occur. A flu-like "post-ablation syndrome", with fever and tiredness for a few days afterwards, is also common.

These rates come from different sources and cannot be compared directly. Review figures pool many studies and vary with hospital experience and patient condition.

Rarely, bile duct injury, worsening liver function, injury to nearby organs (bowel, gallbladder, lung, stomach, kidney) and spread of cancer cells along the needle track have been reported. Japan's Cancer Information Service lists fever, abdominal pain, bleeding, bowel injury, liver dysfunction, and pain or burns at the needle site as complications. The UW Medicine guide says to go to the emergency department right away for a fever above 38.3°C (101°F) or chills, bleeding that does not stop after about 15 minutes of pressure, shortness of breath or new chest pain, or yellowing of the eyes or skin.

How US, UK and Japanese guidance differ

This compares each organisation's public patient guide as written; it is not the standard for every hospital in that country.

The clearest difference is anaesthesia. The US and UK hospital guides use general anaesthesia as standard so that the patient stays still, while the Japanese guide describes local anaesthesia of the abdomen with painkillers and sedatives added during heating. When looking into treatment abroad, this difference can change pre-procedure tests (whether an anaesthesia visit is needed), fasting times, length of stay and cost, so it is best to confirm directly with the hospital. Foreign patients are often not covered by the country's public insurance, which should also be considered.

What to check and questions for your doctor

• Given the size, number and location of my tumours, which suits me best — RFA, microwave ablation, surgery or TACE — and why?
• Will I have general anaesthesia, or local anaesthesia with sedation? When should I start fasting?
• When should I stop and restart my blood thinners or diabetes medicines?
• How many nights will I stay, and what are the discharge criteria? When is it safe to fly?
• When is the first check CT or MRI, and what happens if tumour remains?
• How many liver RFA procedures does this hospital perform, and what is its experience with complications such as bleeding?

For consultation preparation, see five questions to ask before an RFA consultation, and for reading study figures, see how to check the study phase of overseas papers.

Frequently asked questions

How long is the hospital stay after RFA for liver cancer?

It depends on the country and hospital. UW Medicine says patients usually go home the same day, Cambridge University Hospitals says most stay one night, and IASIOS patient material says most go home within 24–48 hours. The National Cancer Center Japan guide mentions only several hours of rest, so check with the hospital.

How long is recovery after radiofrequency ablation?

Symptoms such as abdominal pain, low fever and tiredness settle in about a week according to the US guide and within one to two weeks according to the UK guide. Guidance advises avoiding heavy lifting and strenuous exercise for at least 48–72 hours, and the first check scan is done between 4 weeks and 3 months.

Does liver RFA hurt?

During the procedure, pain is reduced with general anaesthesia or local anaesthesia and sedation. Afterwards, according to IASIOS, up to about half of patients feel mild to moderate pain that is controlled with medicine. The tip of the right shoulder may also ache.

How often do major complications occur?

In a 2014 systematic review of complications after percutaneous liver tumour ablation, the major complication rate for RFA was 4.1% and procedure-related mortality was 0.15%, with bleeding the most frequent major complication. Risk varies with the degree of cirrhosis and tumour location.

Related: the liver function, staging and blood tests done before ablation are explained in pre-procedure tests for liver cancer.

This article summarises public patient guides from overseas organisations and published papers as general information; it is not medical advice. Discuss treatment choices with the doctors who examine you in person.