Radiofrequency Ablation Versus Surgical Resection for Hepatocellular Carcinoma in Childs A Cirrhotics—a Retrospective Study of 1,061 Cases
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.Get Access
The long-term outcomes of radiofrequency ablation (RFA) vs. surgical resection in cirrhotic patients with hepatocellular carcinoma (HCC) remain controversial. One thousand sixty-one cirrhotic HCC patients were included into a retrospective study. Four hundred thirteen received RFA and 648 received surgical resection.
Overall (OS), recurrence-free (RFS), and tumor-free survival (TFS) were compared between the two groups and in subgroup analyses. The 5-year OS and corresponding RFS as well as DFS were significantly higher in the surgical resection group compared with the RFA group (p < 0.001, p < 0.001, p < 0.001). In subgroup analyses of solitary HCC ≤3 cm, there was no significant difference in RFS between the two groups (p = 0.719). Nonetheless, surgical resection was superior to RFA for OS and TFS in this subgroup as well as for OS, RFS, and TFS in subgroup analyses for solitary lesions 3 cm < HCC < 5 cm and multifocal HCC. Serum AFP was the only significant predicting factor for all survival analyses.
When treating Childs A cirrhotic patients with solitary HCC larger than 3 cm but less than 5 cm, or with two or three lesions each less than 5 cm, surgical resection provides a better survival than RFA. When treating Childs A cirrhotics with solitary HCC ≤ 3 cm, RFA has a comparable RFS to surgical resection, but RFA is less invasive.
- Srikanth Padma, John B. Martinie, David A.Iannitti. Liver Tumor Ablation: Percutaneous and Open Approaches. J Surg Oncology. 2009;100:619–634. CrossRef
- Taylor-Robinson SD, Foster GR, Arora S, Hargreaves S, Thomas HC. Increase in Primary Liver Cancer in the UK 1979–94. Lancet.1997; 350:1142–1143. CrossRef
- El-Serag H B, and Mason A C. Rising Incidence of Hepatocellular Carcinoma in the United States. N Engl J Med. 1999; 340:745–750. CrossRef
- Llovet J M and Bruix J. Novel Advancements in the Management of Hepatocellular Carcinoma in 2008. J Hepatology. 2008; 48:s20–s37. CrossRef
- Llovet JM, Burroughs A, Bruix J. Hepatocellular carcinoma. Lancet.2003; 362: 1907–17. CrossRef
- Lai EC, Fan ST, Lo CM, Chu KM, Liu CL, Wong J. Hepatic resection for hepatocellular carcinoma. An audit of 343 patients. Ann Surg. 1995;221:291–8. CrossRef
- Lencioni R, Cioni D, Crocetti L, Franchini C, Pina CD, Lera J, Bartolozzi C. Early-stage hepatocellular carcinoma in patients with cirrhosis: long-term results of percutaneous image-guided radiofrequency ablation. Radiology. 2005;234:961–7. CrossRef
- Tateishi R, Shiina S, Teratani T, Obi S, Sato S, Koike Y, Fujishima T, Yoshida H, Kawabe T, Omata M. Percutaneous radiofrequency ablation for hepatocellular carcinoma. An analysis of 1,000 cases. Cancer 2005;103:1201–9. CrossRef
- Lau WY, Leung TW, Yu SC, Ho SK. Percutaneous local ablative therapy for hepatocellular carcinoma: a review and look into the future. Ann Surg. 2003;237:171–9. CrossRef
- Curley SA. Radiofrequency ablation of malignant liver tumors. Oncologist. 2001;6:14–23. CrossRef
- S. Mulier, P. Mulier, Y. Ni, Y. Miao, B. Dupas, G. Marchal, I. De Wever, L. Michel. Complications of radiofrequency coagulation of liver tumors. Br J Surg. 2002;89:1206–22. CrossRef
- Chen MS, Li JQ, Zheng Y, Guo RP, Liang HH, Zhang YQ, Lin XJ, Lau WY. A prospective randomized trial comparing percutaneous local ablative therapy and partial hepatectomy for small hepatocellular carcinoma. Ann Surg. 2006;243:321–8. CrossRef
- Bonny C, Abergel A, Gayard P, Chouzet S, Ughetto S, Slim K, Rosenfeld L, Guillon R, Poincloux L, Bommelaer G. Radiofrequency Ablation of Hepatocellular Carcinoma in Patients with Cirrhosis. Gastroenterol Clin Biol. 2002; 26:735–741.
- Bruix J, Sherman M, Llovet JM, Beaugrand M, Lencioni R, Burroughs AK, Christensen E, Pagliaro L, Colombo M, Rodés J; EASL Panel of Experts on HCC. 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. CrossRef
- J. Belghiti; P-A Clavien; E. Gadzijev; JO Garden; W-Y Lau; M. Makuuchi; RW Strong. The Brisbane 2000 terminology of liver anatomy and resection. Terminology Committee of the International Hepato-Pancreato-Biliary Association. HPB. 2000; 2:333–9.
- Hashikura Y, Kawasaki S, Terada M, Ikegami T, Nakazawa Y, Urata K, Chisuwa H, Mita A, Ohno Y, Miyagawa S. Long-term Results of Living-Related Donor Liver Graft Transplantation: a Single Center Analysis of 110 Patients. Transplantation. 2001;72:95–99. CrossRef
- 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. CrossRef
- 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. CrossRef
- Wakai T, Shirai Y, Suda T, Yokoyama N, Sakata J, Cruz PV, 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.
- Shi M, Zhang CQ, Zhang YQ, Liang XM, Li JQ. Micrometastasis of Solitary Hepatocellular Carcinoma and Appropriate Resection Margin. World J Surg. 2004; 28:376–381. CrossRef
- Regimbeau JM, Kianmanesh R, Farges O, Dondero F, Sauvanet A, Belghiti J. Extent of Liver Resection Influences the Outcome in Patient with Cirrhosis and Small Hepatocellular Carcinoma. Surgery. 2002; 131:311–317. CrossRef
- Hasegawa K, Kokudo N, Imamura H, Matsuyama Y, Aoki T, Minagawa M, Sano K, Sugawara Y, Takayama T, Makuuchi M. Prognostic Impact of Anatomic Resection for Hepatocellular Carcinoma. Ann Surg. 2005; 242:252–259. CrossRef
- Sasaki A, Kai S, Iwashita Y, Hirano S, Ohta M, Kitano S. Microsatellite Distribution and Indication for Locoregional Therapy in Small Hepatocellular Carcinoma. Cancer. 2005; 103:299–306. CrossRef
- 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.
- Shi M, Guo RP, Lin XJ, Zhang YQ, Chen MS, Zhang CQ, Lau WY, Li JQ. Partial Hepatectomy with Wide Versus Narrow Resection Margin for Solitary Hepatocellular Carcinoma. Ann Surg.2007; 245:36–43. CrossRef
- Takuma Teratani, Haruhiko Yoshida, Shuichiro Shiina, Shuntaro Obi, Shinpei Sato, Ryosuke Tateishi, Norio Mine, Yuji Kondo, Takao Kawabe, Masao Omata. Radiofrequency Ablation for Hepatocellular Carcinoma in So-called High-Risk Locations. Hepatology2006; 45(3),1101–1108. CrossRef
- Liang HH, Chen MS, Peng ZW, Zhang YJ, Zhang YQ, Li JQ, Lau WY. Percutaneous Radiofrequency Ablation Versus Repeat Hepatectomy for Recurrent Hepatocellular Carcinoma: a Retrospective Study. Ann Surg Oncol 2008; 15: 3484–3493. CrossRef
- N'Kontchou G, Mahamoudi A, Aout M, Ganne-Carrié N, Grando V, Coderc E, Vicaut E, Trinchet JC, Sellier N, Beaugrand M, Seror O. Radiofrequency Ablation of Hepatocellular Carcinoma: Long-term Results and Prognostic Factors in 235 Western Patients with Cirrhosis. Hepatology 2009; 50: 1475–1483. CrossRef
- Miyaaki H, Naskashima O, Kurogi M, Eguchi K, kojiro M. Lens Culinaris Aggluntinin-Reactive Alpha-Fetoprotein and Protein Induced by Vitamin K AbsenceII Are Potential Indicators of Poor Prognosis: a Histopathological Study of Surgically Resected Hepatocellular Carcinoma. J Gastroenterol 2007; 42: 962–968. CrossRef
- Bruce MG, Bruden D, McMahon BJ, Christensen C, Homan C, Sullivan D, Deubner H, Williams J, Livingston SE, Gretch D. Clinical Significance of Elevated Alpha-Fetoprotein in Alaskan Native Patients with Chronic Hepatitis C. J Viral Hepat. 2008 Mar; 15(3):179–87. CrossRef
- Chen TM, Huang PT, Tsai MH, Lin LF, Liu CC, Ho KS, Siauw CP, Chao PL, Tung JN. Predictors of Alpha-Fetoprotein Elevation in Patients with Chronic Hepatitis C, But not Hepatocellular Carcinoma, and Its Normalization After Pegylated Interferon Alfa 2a-Ribavirin Combination Therapy. J Gastroenterol Hepatol. 2007 May; 22(5):669–75. CrossRef
- Radiofrequency Ablation Versus Surgical Resection for Hepatocellular Carcinoma in Childs A Cirrhotics—a Retrospective Study of 1,061 Cases
Journal of Gastrointestinal Surgery
Volume 15, Issue 2 , pp 311-320
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- Radiofrequency ablation
- Hepatocellular carcinoma
- Industry Sectors
- Author Affiliations
- 1. Department of Hepato-Biliary-Pancreatic Surgery, Treatment Centre of Liver Cancer, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- 2. From Department of Surgery, University of Western Ontario, Hepatobiliary and Liver Transplant Surgery, London Health Sciences Centre, London, Ontario, Canada