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Surgeons continue to have an important role in the management of patients with hepatic malignancies. Throughout the decades, modern surgical techniques have improved outcomes in patients undergoing hepatic surgery. However, the majority of hepatic malignancies continue to be unamenable to surgical resection. These patients continue to be challenging for clinicians. Surgeons have carried out hepatic tumor ablation since the 1970s; therefore, a vast experience has been gained in terms of techniques, outcomes, and patient selection for tumor ablation. Cryosurgical ablation has been performed for the past several decades, and long-term patient outcome data currently are available. The experience and outcome with cryoablation can be extrapolated to more modern modalities of tumor ablation, such as with radiofrequency energy. In the early 1990s, developments in laparoscopic surgery influenced hepatic surgery.

Percutaneous image-guided radiofrequency (RF) tumor ablation continues to gain momentum in adult patients as a viable and effective therapeutic option in the treatment of solid tumors in a variety of locations including the skeleton, liver, spleen, kidney, adrenal gland, and lung (–). In all these areas, the basic concept of RF tumor ablation is similar: localized and contained heat generation systematically induces focal coagulative necrosis and cell death. Cytotoxicity is best induced when regional temperatures reach and maintain 50° to 100°C. In children, RF tumor ablation has been used most widely in the treatment of osteoid osteoma. Percutaneous RF ablation (RFA) has fewer indications in the pediatric population, and hence, has been slower to evolve in the treatment of diseases of the liver, kidney, lung, and soft tissues.

To round out the comprehensive ablation story, we thought who better to tell it than the patients and families themselves. Finding the initial few patients whom we broached the idea to contribute to be receptive, if not enthusiastic, we decided to include a whole chapter devoted to this perspective on ablation. Thus included are the views on ablation from six patients (with family input). We asked the patients to be candid, and edited and redacted only names to ensure privacy.