Radiofréquences peropératoires des métastases hépatiques : l'âge de raison

Intraoperative radiofrequency ablation (IORA) is a surgical technique used to destroy liver metastases by heat. It is performed by a surgeon experienced in intraoperative ultrasounds. It has been officially registered in the French nomenclature of medical acts in 2009. Indications and results of IORA are very different from those of the percutaneous route used by radiologists. Ten years of experience have allowed to define IORA indications in complement to resection which remains the gold standard of liver surgery: 1) lesion no greater than 30 mm in diameter; 2) no proximity to a major portal structure; 3) use of a straight needle with overlapping heat volumes; 4) complete vascular exclusion (portal and sus-hepatic circulation) to treat para-sus-hepatic lesions; 5) requirement to spare parenchymal liver volume. Positive preliminary data of two prospective studies, the EORTCC CLOCC study and the ARF2003 study confirm that IORA complements surgery to obtain complete resection in a larger proportion of patients after chemotherapy induction.