Journal of Gastrointestinal Surgery

, Volume 15, Issue 2, pp 311–320

Radiofrequency Ablation Versus Surgical Resection for Hepatocellular Carcinoma in Childs A Cirrhotics—a Retrospective Study of 1,061 Cases

  • Jiwei Huang
  • Roberto Hernandez-Alejandro
  • Kristopher P. Croome
  • Lvnan Yan
  • Hong Wu
  • Zheyu Chen
  • Pankaj Prasoon
  • Yong Zeng
Original Article

Abstract

Introduction

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.

Results

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.

Conclusions

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.

Keywords

Radiofrequency ablation Hepatectomy Hepatocellular carcinoma 

References

  1. 1.
    Srikanth Padma, John B. Martinie, David A.Iannitti. Liver Tumor Ablation: Percutaneous and Open Approaches. J Surg Oncology. 2009;100:619–634.CrossRefGoogle Scholar
  2. 2.
    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.CrossRefPubMedGoogle Scholar
  3. 3.
    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.CrossRefPubMedGoogle Scholar
  4. 4.
    Llovet J M and Bruix J. Novel Advancements in the Management of Hepatocellular Carcinoma in 2008. J Hepatology. 2008; 48:s20–s37.CrossRefGoogle Scholar
  5. 5.
    Llovet JM, Burroughs A, Bruix J. Hepatocellular carcinoma. Lancet.2003; 362: 1907–17.CrossRefPubMedGoogle Scholar
  6. 6.
    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.CrossRefPubMedGoogle Scholar
  7. 7.
    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.CrossRefPubMedGoogle Scholar
  8. 8.
    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.CrossRefPubMedGoogle Scholar
  9. 9.
    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.CrossRefPubMedGoogle Scholar
  10. 10.
    Curley SA. Radiofrequency ablation of malignant liver tumors. Oncologist. 2001;6:14–23.CrossRefGoogle Scholar
  11. 11.
    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.CrossRefPubMedGoogle Scholar
  12. 12.
    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.CrossRefPubMedGoogle Scholar
  13. 13.
    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.PubMedGoogle Scholar
  14. 14.
    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.CrossRefPubMedGoogle Scholar
  15. 15.
    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.Google Scholar
  16. 16.
    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.CrossRefPubMedGoogle Scholar
  17. 17.
    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.CrossRefPubMedGoogle Scholar
  18. 18.
    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.CrossRefPubMedGoogle Scholar
  19. 19.
    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.PubMedGoogle Scholar
  20. 20.
    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.CrossRefPubMedGoogle Scholar
  21. 21.
    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.CrossRefPubMedGoogle Scholar
  22. 22.
    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.CrossRefPubMedGoogle Scholar
  23. 23.
    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.CrossRefPubMedGoogle Scholar
  24. 24.
    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.PubMedGoogle Scholar
  25. 25.
    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.CrossRefPubMedGoogle Scholar
  26. 26.
    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.CrossRefGoogle Scholar
  27. 27.
    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.CrossRefPubMedGoogle Scholar
  28. 28.
    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.CrossRefPubMedGoogle Scholar
  29. 29.
    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.CrossRefPubMedGoogle Scholar
  30. 30.
    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.CrossRefPubMedGoogle Scholar
  31. 31.
    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.CrossRefPubMedGoogle Scholar

Copyright information

© The Society for Surgery of the Alimentary Tract 2010

Authors and Affiliations

  • Jiwei Huang
    • 1
  • Roberto Hernandez-Alejandro
    • 2
  • Kristopher P. Croome
    • 2
  • Lvnan Yan
    • 1
  • Hong Wu
    • 1
  • Zheyu Chen
    • 1
  • Pankaj Prasoon
    • 1
  • Yong Zeng
    • 1
  1. 1.Department of Hepato-Biliary-Pancreatic Surgery, Treatment Centre of Liver Cancer, West China HospitalSichuan UniversityChengduChina
  2. 2.From Department of SurgeryUniversity of Western Ontario, Hepatobiliary and Liver Transplant Surgery, London Health Sciences CentreLondonCanada

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