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Thermal ablation; radiofrequency ablation (RFA) and microwave coagulation therapy (MCT) has spread widely as a less invasive and curative treatment for hepatocellular carcinoma (HCC). “Thermal ablation program in Kumamoto University” has been continued for over 20 years. From 1994 to 2010, thermal ablation was applied for 807 HCC patients; percutaneous, endoscopic and open ablation were applied for 420 patients (52%), 298 (37%) and 89 (11%), respectively. Long-term survival was excellent; 3-, 5-, and 10-year cumulative overall survival rates were 68%, 52% and 29%, respectively. In contrast, there observed some adverse events in thermal ablation mainly in the early period. Complication rates in 200 MCT and 230 RFA were 10% and 5%, respectively. In this paper, we introduced several complications and its management and preventive method Thermal ablation has a dark side of providing severe complications for a couple of patients, therefore observance of strict indication is always required. Abbreviations: HCC, hepatocellular carcinoma; RFA, radiofrequency ablation; MCT, microwave coagulation therapy; TACE, transarterial chemoembolization; PEIT, percutaneous ethanol injection therapy; OS, overall survival

Bright side and dark side of thermal ablation for hepatocellular carcinoma