Managing Intestinal Perforation After Liver Ablation Therapy: What to Know

What to do if liver ablation treatment leads to intestinal perforation?

Hello, Doctor.
My father is 74 years old and has liver cancer.
After the Lunar New Year this year, he underwent "radiofrequency ablation therapy" for his liver.
He had previously undergone the same treatment multiple times with the same physician at the same hospital.
However, this time, in addition to the usual discomfort after the procedure, his overall health rapidly deteriorated, leading to symptoms such as weakness in his limbs, inability to stand or walk, and insomnia—conditions he had never experienced before.
When he returned for a follow-up appointment the following week, the attending physician informed us that the "radiofrequency ablation therapy" had resulted in "intestinal perforation," which caused a rapid decline in his bodily functions.
Within 2 to 3 months post-surgery, he reached a state where he could no longer manage his own bowel or bladder functions.
The attending physician mentioned two options: one was to perform surgery to address the intestinal perforation, but he estimated that my father would have about one month left to live post-surgery; the other option was to let nature take its course and possibly manage symptoms with medication.

I would like to ask:
1.
Is intestinal perforation a common complication of radiofrequency ablation therapy? The doctor seemed to imply it was as common as finding a convenience store around the corner.
2.
Given that intestinal perforation has already occurred, are there any other treatment options available besides the two mentioned?
3.
Will my father's current inability to care for himself persist until the end of his life, or could his condition improve if the intestinal perforation heals or gets better?
I have been unable to find answers to these questions through Google or other resources.
I would greatly appreciate it if you could take the time to respond.
Thank you very much!

Da Dong, 30~39 year old female. Ask Date: 2024/05/27

Dr. Chen Jiaming reply Surgery

The occurrence of intestinal perforation due to ablative treatment for liver tumors is not very common, but it is indeed a potential complication associated with this treatment method.
During the process of ablating the liver tumor, heat is generated, and the peristaltic movement of the intestines within the abdominal cavity cannot be completely controlled.
If the intestines that are traversed during the procedure are affected by the heat, it can indeed lead to perforation.
This situation presents a dilemma whether to proceed with surgery or not, as this involves your family member and not a mere subject for experimentation.
However, your physician has provided all necessary information, and it is up to you to discuss and make a decision.
If the individual has been in a state of dependency for a significant period, even if the intestinal perforation improves or heals (for example, through surgery), it is difficult to guarantee the level of recovery.
There is also a possibility that post-surgery, the individual may experience further deterioration due to loss of physical strength.
I hope this response is helpful to you.

Reply Date: 2024/05/27

More Info

Managing intestinal perforation after liver ablation therapy is a complex and serious issue, particularly in elderly patients with pre-existing conditions such as liver cancer. Your father's situation, following the liver ablation therapy, raises several important considerations regarding the risks, treatment options, and potential outcomes.

Frequency of Intestinal Perforation Post-Ablation
Intestinal perforation is a rare but serious complication of liver ablation therapies, including radiofrequency ablation (RFA) and microwave ablation. While the incidence is not extremely high, it can occur, particularly if the ablation is performed near the gastrointestinal tract. The risk factors for perforation can include the size and location of the tumor, the technique used, and the overall health of the patient. It is concerning that your father's physician described this complication as "common," as it may indicate a lack of caution or thoroughness in the procedure.

Treatment Options for Intestinal Perforation
Once intestinal perforation occurs, the primary treatment is surgical intervention to repair the perforation. This typically involves laparotomy or laparoscopy, depending on the severity and location of the perforation. However, surgery carries its own risks, especially in patients who are already weakened by cancer and its treatments.
In your father's case, the physician presented two options: surgical repair of the perforation or palliative care. The decision to proceed with surgery should consider several factors, including:
1. Overall Health Status: If your father is in a weakened state, surgery may pose significant risks, including complications from anesthesia and recovery challenges.

2. Quality of Life: If surgery is likely to improve his quality of life and extend his time, it may be worth considering despite the risks.

3. Palliative Care: If surgery is deemed too risky, focusing on palliative care to manage symptoms and improve comfort may be the best approach.

Prognosis and Quality of Life
Regarding your father's current inability to care for himself, this condition may persist if the underlying issue of the intestinal perforation is not addressed. If the perforation is repaired successfully, there is a possibility that his overall condition could improve, allowing for better self-care and quality of life. However, the prognosis can vary widely based on individual health factors, the extent of the cancer, and any other comorbidities.

Conclusion
In summary, intestinal perforation following liver ablation therapy is a serious complication that requires careful consideration of treatment options. Surgical intervention is the primary method of addressing the perforation, but it comes with risks, especially in frail patients. Palliative care may be appropriate if surgery is not feasible. The potential for recovery and improvement in quality of life depends on the successful management of the perforation and the overall health of your father. It is crucial to have open discussions with the healthcare team about the risks and benefits of each option to make an informed decision that aligns with your father's wishes and quality of life goals.

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