Multimodal radiofrequency ablation versus laparoscopic hepatic resection for the treatment of primary hepatocellular carcinoma within Milan criteria in severely cirrhotic patients: long-term favorable outcomes over 10 years
Less invasiveness is an important consideration for the treatment of hepatocellular carcinoma (HCC) especially in patients with severe cirrhosis.
Between April 2000 and September 2016, 100 patients with liver damage B underwent multimodal radiofrequency ablation (RFA; n = 62) or laparoscopic hepatic resection (Lap-HR; n = 38) for primary HCC as defined by the Milan criteria. We compared the operative outcomes and patients’ survival between the two groups.
The RFA group showed worse liver functions as indicated by indocyanine green retention rate (32.9 vs. 22.4%; p < 0.0001) and serum albumin value (3.3 vs. 3.6 g/dl; p = 0.0029). As expected, RFA was less invasive, as indicated by the differences in operation time (166 vs. 288 min.; p < 0.0001) and blood loss (8 vs. 377 g; p < 0.0001). There was no significant difference in the morbidity rate between the two groups; however, the duration of hospital stay of the RFA group was significantly shorter (7 vs. 11 days; p = 0.0002). There were no significant between-group differences regarding overall or disease-free survival.
Multimodal RFA for HCC in patients with severe cirrhosis is associated with less invasiveness and shorter hospital stays, with no compromise in the patients’ survival. In patients with severe cirrhosis, it may be time to consider changing the standard treatment for primary HCC within the Milan criteria to multimodal RFA.
KeywordsRadiofrequency ablation (RFA) Laparoscopic hepatic resection (Lap-HR) Hepatocellular carcinoma (HCC) Liver damage Overall survival (OS) Disease-free survival (DFS)
Compliance with ethical standards
Yo-ichi Yamashita, Katsunori Imai, Takayoshi Kaida, Takanobu Yamao, Masayo Tsukamoto, Shigeki Nakagawa, Hirohisa Okabe, Akira Chikamoto, Takatoshi Ishiko, Tomoharu Yoshizumi, Tetsuo Ikeda, Yoshihiko Maehara, and Hideo Baba have no conflict of interest or financial ties to disclose.
- 2.Yamashita YI, Tsuijita E, Takeishi K, Ishida T, Ikegami T, Ezaki T, Maeda T, Utsunomiya T, Nagasue N, Shirabe K, Maehara Y (2014) Trends in surgical results of hepatic resection for hepatocellular carcinoma: 1000 consecutive cases over 20 years in a single institution. Am J Surg 207:890–896CrossRefGoogle Scholar
- 4.Yamashita Y, Ikeda T, Kurihara T, Yoshida Y, Takeishi K, Itoh S, Harimoto N, Kawanaka H, Shirabe K, Maehara Y (2014) Long-term favorable surgical results of laparoscopic hepatic resection for hepatocellular carcinoma in patients with cirrhosis: a single-center experience over a 10-year period. J Am Coll Surg 219:1117–1123CrossRefGoogle Scholar
- 5.Ishiko T, Beppu T, Sugiyama S, Masuda T, Takahashi M, Komori H, Takamori H, Hirota M, Kanemitu K, Baba H (2008) Radiofrequency ablation with hand-assisted laparoscopic surgery for the treatment of hepatocellular carcinoma in the caudate lobe. Surg Laparosc Endosc Percutan Tech 18:272–276CrossRefGoogle Scholar
- 6.Ishiko T, Beppu T, Chikamoto A, Imai K, Okabe H, Hayashi H, Nitta H, Baba H (2013) Thoracoscopic local ablation with diaphragmatic incision method for liver surface tumor in the hepatic dome. Surg Laparosc Endosc Percutan Tech 23(4):415–418. https://doi.org/10.1097/SLE.0b013e31828e3bba CrossRefGoogle Scholar
- 9.Makuuchi M, Kokudo N, Arii S, Futagawa S, Kaneko S, Kawasaki S, Matsuyama Y, Okazaki M, Okita K, Omata M, Saida Y, Takayama T, Yamaoka Y (2008) Development of evidence-based clinical guidelines for the diagnosis and treatment of hepatocellular carcinoma in Japan. Hepatol Res 38:37–51CrossRefGoogle Scholar
- 12.Yamashita Y, Yoshida Y, Kurihara T, Itoh S, Harimoto N, Ikegami T, Yoshizumi T, Uchiyama H, Shirabe K (2015) Maehara Y. Surgical results for recurrent hepatocellular carcinoma after curative hepatectomy: Repeat hepatectomy versus salvage living donor liver transplantation. Liver Transpl 21:961–968CrossRefGoogle Scholar
- 13.Doi K, Beppu T, Ishiko T, Chikamoto A, Hayashi H, Imai K, Nitta H, Baba Y, Masuda T, Okabe K, Kuramoto M, Kudo K, Ogata K, Ohchi T, Takamori H, Kikuchi K, Baba H (2015) Endoscopic radiofrequency ablation in elderly patients with hepatocellular carcinoma. Anticancer Res 35:3033–3040Google Scholar
- 14.Imai K, Beppu T, Chikamoto A, Doi K, Okabe H, Hayashi H, Nitta H, Ishiko T, Takamori H, Baba H. Comparison between hepatic resection and radiofrequency ablation as first-line treatment for solitary small-sized hepatocellular carcinoma of 3 cm or less. Hepatol Res 43: 853–64, 2013CrossRefGoogle Scholar
- 15.Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD, de Santibañes E, Pekolj J, Slankamenac K, Bassi C, Graf R, Vonlanthen R, Padbury R, Cameron JL, Makuuchi M. The Clavien-Dindo classification of surgical complications: 5-year experience. Ann Surg 250: 187–96, 2009CrossRefGoogle Scholar
- 18.Kokudo N, Hasegawa K, Akahane M, Igaki H, Izumi N, Ichida T, Uemoto S, Kaneko S, Kawasaki S, Ku Y, Kudo M, Kubo S, Takayama T, Tateishi R, Fukuda T, Matsui O, Matsuyama Y, Murakami T, Arii S, Okazaki M, Makuuchi M. Evidence-based Clinical Practice Guidelines for Hepatocellular Carcinoma: The Japan Society of Hepatology 2013 update (3rd JSH-HCC Guidelines). Hepatol Res. 2015 https://doi.org/10.1111/hepr.12464 Google Scholar
- 22.Morise Z, Ciria R, Cherqui D, Chen KH, Belli G, Wakabayashi G. Can we expand the indications for laparoscopic liver resection? A systematic review and meta-analysis of laparoscopic liver resection for patients with hepatocellular carcinoma and chronic liver disease. J Hepatobiliary Pancreat Sci 22: 342–52, 2015CrossRefGoogle Scholar
- 25.Liver Cancer Study Group of Japan. General Rules for the Clinical and Pathological Study of Primary Liver Cancer, 3. Tokyo: Kanehara & Co., Ltd., 2010Google Scholar
- 28.Mima K, Hayashi H, Imai K, Kuroki H, Nakagawa S, Okabe H, Chikamoto A, Watanabe M, Beppu T, Baba H. High CD44s expression is associated with the EMT expression profile and intrahepatic dissemination of hepatocellular carcinoma after local ablation therapy. J Hepatobiliary Pancreat Sci 20: 429–434, 2013CrossRefGoogle Scholar