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Radiofrequency Ablation Versus Surgical Resection for the Treatment of Hepatocellular Carcinoma in Cirrhosis

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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background and Aims

Percutaneous radiofrequency ablation (RFA) demonstrated good results for the treatment of hepatocellular carcinoma (HCC) in cirrhotic patients; it is still not clear whether the overall survival and disease-free survival after RFA are comparable with surgical resection. The aims of this study are to compare the overall survival and disease-free survival in two groups of cirrhotic patients with HCC submitted to surgery or RFA.

Methods

Two hundred cirrhotic patients with HCCs smaller than 6 cm were included in this retrospective study: 109 underwent RFA and 91 underwent surgical resection at a single Division of Surgery of University of Verona.

Results

Median follow-up time was 27 months. Overall survival was significantly longer in the resection group in comparison with the RFA group with a median survival of 57 and 28 months, respectively (P = 0.01). In Child–Pugh class B patients and in patients with multiple HCC, survival was not significantly different between the two groups. In patients with HCC smaller than 3 cm, the overall survival and disease-free survival for RFA and resection were not significantly different in univariate and multivariate analysis. Whereas in patients with HCC greater than 3 cm, surgery showed improvement in outcome in both univariate and multivariate analysis.

Conclusions

Surgical resection significantly improves the overall survival and disease-free survival in comparison with RFA. In a selected group of patients (Child–Pugh class B, multiple HCC, or in HCC ≤3 cm), the results between the two treatments did not show significant differences.

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References

  1. Bosch FX, Ribes J, Cleries R, Diaz M. Epidemiology of hepatocellular carcinoma. Clin Liver Dis 2005;9(2):191–211.

    Article  PubMed  Google Scholar 

  2. Carr B. Hepatocellular carcinoma: current management and future trends. Gastroenterology 2004;127(5 Suppl 1):S218–S224.

    Article  PubMed  Google Scholar 

  3. Poon RT, Fan ST, Tsang FH, Wong. Locoregional therapies for hepatocellular carcinoma: a critical review from the surgeon’s perspective. Ann Surg 2002;235(4):466–486.

    Article  PubMed  Google Scholar 

  4. Sutherland LM, Williams JA, Padbury RT, Gotley DC, Stokes B, Maddern GJ. Radiofrequency ablation of liver tumors: a systematic review. Arch Surg 2006;141(2):181–190.

    Article  PubMed  Google Scholar 

  5. Ng KKC, Lam CM, Poon RT, et al. Thermal ablative therapy for malignant liver tumors: a critical appraisal. J Gastroenterol Hepatol 2003;18:616–629.

    Article  PubMed  Google Scholar 

  6. Curley S. Radiofrequency ablation of malignant liver tumors. Ann Surg Oncol 2003;10:338–347.

    Article  PubMed  Google Scholar 

  7. Vivarelli M, Guglielmi A, Ruzzenente A, Cucchetti A, Bellusci R, Cordiano C, Cavallari A. Surgical resection versus percutaneous radiofrequency ablation in the treatment of hepatocellular carcinoma on cirrhotic liver. Ann Surg 2004;240(1):102–107.

    Article  PubMed  Google Scholar 

  8. Hong SN, Lee SY, Choi MS, Lee JH, Koh KC, Paik SW, Yoo BC, Rhee JC, Choi D, Lim HK, Lee KW, Joh JW. Comparing the outcomes of radiofrequency ablation and surgery in patients with a single small hepatocellular carcinoma and well-preserved hepatic function. J Clin Gastroenterol 2005;39(3):247–252.

    Article  PubMed  Google Scholar 

  9. Wakai T, Shirai Y, Suda T, Yokoyama N, Sakata J, Cruz P, Kawai H, Matsuda Y, Watanabe M, Aoyagi Y, Hatakeyama K. Long-term outcomes of hepatectomy vs percutaneous ablation for treatment of hepatocellular carcinoma < or =4 cm. World J Gastroenterol 2006;12(4):546–552.

    PubMed  Google Scholar 

  10. Bruix J, Sherman M, Llovet JM, et al. Clinical management of hepatocellular carcinoma. Conclusions of the Barcelona-2000 EASL conference. European Association for the Study of the Liver. J Hepatol 2001;35:421–430.

    Article  PubMed  CAS  Google Scholar 

  11. Miller AB, Hoogstraten B, Staquet M, Winkler A. Reporting results of cancer treatment. Cancer 1981;47:207–214.

    Article  PubMed  CAS  Google Scholar 

  12. El-Serag HB, Mallat DB, Rabeneck L. Management of the single liver nodule in a cirrhotic patient: a decision analysis model. J Gastroenterol 2005;39(2):152–159.

    Google Scholar 

  13. Taura K, Ikai I, Hatano E, Fujii H, Uyama N, Shimahara Y. Implication of frequent local ablation therapy for intrahepatic recurrence in prolonged survival of patients with hepatocellular carcinoma undergoing hepatic resection: an analysis of 610 patients over 16 years old. Ann Surg 2006;244(2):265–273.

    Article  PubMed  Google Scholar 

  14. Hashikura Y, Kawasaki S, Terada M, et al. Long-term results of living-related donor liver graft transplantation: a single center analysis of 110 patients. Transplantation 2001;72:95–99.

    Article  PubMed  CAS  Google Scholar 

  15. Mazzaferro V, Battiston C, Perrone S, Pulvirenti A, Regalia E, Romito R, Sarli D, Schiavo M, Garbagnati F, Marchiano A, Spreafico C, Camerini T, Mariani L, Miceli R, Andreola S. Radiofrequency ablation of small hepatocellular carcinoma in cirrhotic patients awaiting liver transplantation: a prospective study. Ann Surg 2004;240(5):900–909.

    Article  PubMed  Google Scholar 

  16. Grazi GL, Ercolani G, Pierangeli F, Del Gaudio M, Cescon M, Cavallari A, Mazziotti A. Improved results of liver resection for hepatocellular carcinoma on cirrhosis give the procedure added value. Ann Surg 2001;234(1):71–78.

    Article  PubMed  CAS  Google Scholar 

  17. Poon RT, Fan ST, Lo CM, Liu CL, Lam CM, Yuen WK, Yeung C, Wong J. Extended hepatic resection for hepatocellular carcinoma in patients with cirrhosis: is it justified? Ann Surg 2002;236(5):602–611.

    Article  PubMed  Google Scholar 

  18. Guglielmi A, Ruzzenente A, Battocchia A, Tonon A, Fracastoro G, Cordiano C. Radiofrequency ablation of hepatocellular carcinoma in cirrhotic patients. Hepatogastroenterology 2003;50:480–484.

    PubMed  Google Scholar 

  19. Chen MS, et al. A prospective randomized trial comparing percutaneous local ablative therapy and partial hepatectomy for small hepatocellular carcinoma. Ann Surg 2006;243(3):321–328.

    Article  PubMed  Google Scholar 

  20. Sala M, Llovet JM, Vilana R, et al. Initial response to percutaneous ablation predicts survival in patients with hepatocellular carcinoma. Hepatology 2004;40(6):1352–1360.

    Article  PubMed  Google Scholar 

  21. Guglielmi A, Ruzzenente A, Sandri M, Pachera S, Pedrazzani C, Tasselli S, Iacono C. Radiofrequency ablation for HCC in cirrhotic patients: prognostic factors for survival. J Gastrointest Surg 2007;11(2):143–149, Feb.

    Article  PubMed  Google Scholar 

  22. Toyosaka A, Okamoto E, Mitsunobu M, Oriyama T, Nakao N, Miura K. Intrahepatic metastases in hepatocellular carcinoma: evidence for spread via the portal vein as efferent vessel. Am J Gastroenterol 1996;91(8):1610–1615.

    PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Division of General Surgery “A”, Department of Surgery and Gastroenterology, University of Verona Medical School, GB Rossi University Hospital, Piazzale LA Scuro 10, 37134, Verona, Italy

    Alfredo Guglielmi, Andrea Ruzzenente, Alessandro Valdegamberi, Silvia Pachera, Tommaso Campagnaro, Paola Nicoli & Calogero Iacono

  2. Department of Radiology, University of Verona Medical School, GB Rossi University Hospital, Piazzale LA Scuro 10, 37134, Verona, Italy

    Mirko D’Onofrio & Enrico Martone

Authors
  1. Alfredo Guglielmi
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  2. Andrea Ruzzenente
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  3. Alessandro Valdegamberi
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  4. Silvia Pachera
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  5. Tommaso Campagnaro
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  6. Mirko D’Onofrio
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  7. Enrico Martone
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  8. Paola Nicoli
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  9. Calogero Iacono
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Correspondence to Alfredo Guglielmi.

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Guglielmi, A., Ruzzenente, A., Valdegamberi, A. et al. Radiofrequency Ablation Versus Surgical Resection for the Treatment of Hepatocellular Carcinoma in Cirrhosis. J Gastrointest Surg 12, 192–198 (2008). https://doi.org/10.1007/s11605-007-0392-8

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  • DOI: https://doi.org/10.1007/s11605-007-0392-8

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