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Efficacy and safety of radiofrequency ablation versus minimally invasive liver surgery for small hepatocellular carcinoma: a systematic review and meta-analysis

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Abstract

Background

The aim of this study was to compare radiofrequency ablation (RFA) with minimally invasive liver surgery (MIS) in the treatment of small hepatocellular carcinoma (SHCC) and to assess short-term and long-term clinical outcomes.

Methods

PubMed, Embase, Cochrane Library, Web of science, and CBM were systematically searched for articles from inception to July 2018, comparing RFA and MIS in SHCC treatment. We evaluated overall survival (OS), disease-free survival (DFS), local recurrence, and complication rates, as well as hospitalization duration and operation times.

Results

Six retrospective studies were analyzed, including a total of 597 patients, 313 treated with RFA and 284 treated with MIS. OS rates were significantly higher in patients treated with MIS at 3 years, when compared to RFA (OR 0.55; 95% CI 0.36 to 0.84). The 3-year DFS MIS rates were also superior to RFA (OR 0.63; 95% CI 0.41 to 0.98). In contrast, when compared to MIS, RFA demonstrated a significantly higher rate of local intrahepatic recurrences, (OR 2.24; 95% CI 1.47 to 3.42), and a lower incidence of postoperative complications (OR 0.34; 95% CI 0.22 to 0.53), as well as shorter operation times (OR − 145.31, 95% CI − 200.24 to − 90.38) and hospitalization duration (OR − 4.02,95% CI − 4.94 to − 3.10).

Conclusions

We found that MIS led to higher OS, DFS, and lower local recurrences in SHCC patients. Meanwhile, RFA treatments led to significantly lower complication rates, shorter operation times, and hospitalization duration. Considering long-term outcomes, MIS was found to be superior to RFA. However, RFA may be an alternative treatment for patients presenting a single SHCC nodule (≤ 3 cm), given its minimally invasive nature and its comparable long-term efficacy with MIS. Nevertheless, our findings should be explained with caution due to the low level of evidence obtained.

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Acknowledgements

The authors thank the institution (Evidence Based Medicine Center of Lanzhou University) for their help and support to the methodology and meta process.

Disclosure

Mou-Bo Si, Pei-Jing Yan, Xiang-Yong Hao, Zhen-Ying Du, Hong-Wei Tian, Jia Yang, Cai-Wen Han, Ke-Hu Yang, and Tian-Kang Guo have declared that they have no conflicts of interest or financial ties to disclose.

Funding

Supported by Natural Science Foundation for Young Scientists of Gansu Province and the Science & Technology Planning Project of Gansu Province (Grant No.: 18JR3RA058). Supported by Key Laboratory of Evidence Based Medicine and Knowledge Translation Foundation of Gansu Province (Grant No. GSXZYZH2018006). Supported by Foundation of Lanzhou Science and Technology Bureau (Grant No. 2017-ZD-38). Supported by Research Projects of Gansu Provincial Hospital (Grant No.18GSSY3-1). Supported by Research Projects of Gansu Provincial Hospital (Grant No. 18GSSY3-8).

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Author notes

  1. Mou-Bo Si and Pei-Jing Yan are Co-first authors.

Authors and Affiliations

  1. Department of General Surgery, Gansu Provincial Hospital, Donggang West Road, Lanzhou, 730000, People’s Republic of China

    Mou-Bo Si, Xiang-Yong Hao, Hong-Wei Tian, Jia Yang, Cai-Wen Han & Tian-Kang Guo

  2. Department of Clinical Medicine, The First Clinical Medical College of Lanzhou University, Lanzhou, 730000, People’s Republic of China

    Mou-Bo Si

  3. Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, 199 Donggang West Road, Lanzhou, 730000, People’s Republic of China

    Ke-Hu Yang

  4. Institution of Clinical Research and Evidence Based Medicine, Gansu Provincial Hospital, Lanzhou, 730000, People’s Republic of China

    Mou-Bo Si, Pei-Jing Yan, Jia Yang, Cai-Wen Han, Ke-Hu Yang & Tian-Kang Guo

  5. Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, 730000, Gansu, People’s Republic of China

    Ke-Hu Yang

  6. Department of Physiology, Shanxi Medical University, Taiyuan, 030001, China

    Zhen-Ying Du

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Si, MB., Yan, PJ., Hao, XY. et al. Efficacy and safety of radiofrequency ablation versus minimally invasive liver surgery for small hepatocellular carcinoma: a systematic review and meta-analysis. Surg Endosc 33, 2419–2429 (2019). https://doi.org/10.1007/s00464-019-06784-0

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