No-Touch Radiofrequency Ablation for Early Hepatocellular Carcinoma: 2023 Korean Society of Image-Guided Tumor Ablation Guidelines

Incremental High Power Radiofrequency Ablation with Multi-electrodes for Small Hepatocellular Carcinoma: A Prospective Study

“…First, enhanced energy delivery, reaching up to 400 W through DSM mode, adeptly manages impedance rise, which could foster a more consistent heat distribution, and potentially reduce residual tumor post-ablation [21]. Additionally, the gradual energy increment during ablation, applied through electrodes placed peripherally or within the tumor's peritumoral area, may facilitate an early blockade of blood supply and draining portal venule, while also maintaining lower intratumoral pressure [22,29]. This could possibly reduce the likelihood of tumor recurrence by preventing the dispersion of malignant cells around the ablated area, a signi cant concern associated with high-power RF energy delivery [22,38].…”

“…It's noteworthy that we used more oncologically driven ablation techniques like the "no-tumor-touch" method [27,29] in 51 patients or RFA with feeding vessel ablation in another 32 patients [41]. The "notumor-touch" method was our preferred approach over the conventional tumor puncture technique, especially for tumors with ample peritumoral parenchyma and a clear access route.…”

“…The "notumor-touch" method was our preferred approach over the conventional tumor puncture technique, especially for tumors with ample peritumoral parenchyma and a clear access route. Several previous studies [26,27,29,42] have shown that the "no-tumor-touch" RFA method offers enhanced control over local tumors for HCCs ≤ 5 cm compared to the traditional tumor-puncturing method. This superior control is due to the creation of a su cient safety margin, improved thermal e ciency, and the prevention of track seeding [29].…”

“…Several previous studies [26,27,29,42] have shown that the "no-tumor-touch" RFA method offers enhanced control over local tumors for HCCs ≤ 5 cm compared to the traditional tumor-puncturing method. This superior control is due to the creation of a su cient safety margin, improved thermal e ciency, and the prevention of track seeding [29]. When the index tumor is peripherally located, especially near the subsegmental portal vein branch or hepatic arterial branch, we implemented the RFA with feeding vessel ablation technique.…”

“…In this prospective study, we opted for oncologically focused ablation techniques such as the "no-tumortouch" method [26, 27] or RFA with feeding vessel ablation [28]. The choice between "no-tumor-touch" ablation and conventional tumor puncture ablation was based on factors like the availability of su cient peritumoral liver tissue for electrode placement and the feasibility of safely inserting the required multiple electrodes for "no-tumor-touch" ablation [29]. When safely inserting multiple electrodes was not feasible, we used the tumor puncture method, preferring electrode placement in the tumor's periphery.…”