Skip to main content

Advertisement

SpringerLink
Log in

Laparoscopic liver resection is superior to radiofrequency ablation for small hepatocellular carcinoma: a systematic review and meta-analysis of propensity score-matched studies

  • Original Article
  • Published:
Hepatology International Aims and scope Submit manuscript

Abstract

Background

The approach in small hepatocellular carcinoma (HCC) is controversial, no prospective randomized trials to compare ablative or surgical approaches. We compared the surgical and oncological outcomes after laparoscopic hepatectomy (LH) and radiofrequency ablation (RFA) in small HCC patients based on matched cohort studies that performed propensity score matching (PSM).

Methods

We systemically searched the PubMed, Cochrane Library, Embase, Web of Science, and the Chinese BioMedical Literature (CBM) databases. All published propensity score-matched studies that compared LH and RFA for small HCC were included in this study.

Results

Eight studies with a total of 1273 small HCC cases were included. The results of the meta-analysis revealed that there was no significant difference in the 1- year overall survival (OS) rate between the two groups, whereas the LH group had significantly higher 3- year overall survival rate (RR = 1.14, 95% CI 1.08–1.20, p < 0.00001) as well as 1- and 3-year disease-free survival (DFS) rates (RR = 1.31, 95% CI 1.22–1.42, p < 0.00001; RR = 1.66, 95% CI 1.46–1.90, p < 0.00001) than the RFA group. Meanwhile, the local recurrence rate and intrahepatic distant recurrence rate were significantly lower in the LH group than in the RFA group (RR = 0.29, 95% CI 0.20–0.42, p < 0.00001; RR = 0.67, 95% CI 0.49–0.92, p = 0.01). In comparison with the LH group, the RFA group had a lower incidence of overall and major postoperative complications (RR = 1.81, 95% CI 1.47–2.24, p < 0.00001; RR = 2.76, 95% CI 1.48–5.12, p = 0.001), but there was no significant difference in postoperative mortality between the two groups. In addition, further comparison of single postoperative complications showed that the incidence of ascites was lower in the RFA group than in the LH group (RR = 3.62, 95% CI 1.64–7.96, p = 0.001), whereas there was no significant difference in the incidence of postoperative bleeding, abdominal infection and bile leakage between the two groups (RR = 3.50, 95% CI 0.74–16.61, p = 0.11; RR = 5.00, 95% CI 0.59–42.23, p = 0.14; RR = 4.00, 95% CI 0.45–35.23, p = 0.21). Besides, the hospital stay was shorter in the RFA group than in the LH group (MD = 4.29, 95% CI 2.06–6.53, p = 0.0002).

Conclusions

Our meta-analysis demonstrated that in comparison with RFA in the treatment of small HCC, LH provided superior long-term OS and DFS together with lower rates of local and intrahepatic distant recurrence after surgery. However, RFA was associated with better short-term outcomes.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

References

  1. Glantzounis GK, Korkolis D, Sotiropoulos GC, Tzimas G, Karampa A, Paliouras A, et al. Individualized approach in the surgical management of hepatocellular carcinoma: results from a Greek multicentre study. Cancers (Basel). 2022;14(18):4387. https://doi.org/10.3390/cancers14184387

    Article  PubMed  Google Scholar 

  2. Zhang XF, Xue F, Bagante F, Ratti F, Marques HP, Silva S, et al. Non-transplantable recurrence after resection for transplantable hepatocellular carcinoma: implication for upfront treatment choice. J Gastrointest Surg. 2022;26(5):1021–1029. https://doi.org/10.1007/s11605-021-05206-8

    Article  PubMed  Google Scholar 

  3. Delvecchio A, Conticchio M, Riccelli U, Ferraro V, Ratti F, Gelli M, et al. Laparoscopic versus open liver resection for hepatocellular carcinoma in elderly patients: a propensity score matching analysis. HPB (Oxford). 2022;24(6):933–941. https://doi.org/10.1016/j.hpb.2021.10.024

    Article  PubMed  Google Scholar 

  4. Wang Q, Li HJ, Dai XM, Xiang ZQ, Zhu Z. Laparoscopic versus open liver resection for hepatocellular carcinoma in elderly patients: systematic review and meta-analysis of propensity-score matched studies. Int J Surg. 2022;105: 106821. https://doi.org/10.1016/j.ijsu.2022.106821

    Article  PubMed  Google Scholar 

  5. Takayama T, Hasegawa K, Izumi N, Kudo M, Shimada M, Yamanaka N, et al. Surgery versus radiofrequency ablation for small hepatocellular carcinoma: a randomized controlled trial (SURF trial). Liver Cancer. 2022;11(3):209–218. https://doi.org/10.1159/000521665

    Article  CAS  PubMed  Google Scholar 

  6. Feng K, Yan J, Li X, Xia F, Ma K, Wang S, et al. A randomized controlled trial of radiofrequency ablation and surgical resection in the treatment of small hepatocellular carcinoma. J Hepatol. 2012;57(4):794–802. https://doi.org/10.1016/j.jhep.2012.05.007

    Article  PubMed  Google Scholar 

  7. Ogiso S, Seo S, Eso Y, Yoh T, Kawai T, Okumura S, et al. Laparoscopic liver resection versus percutaneous radiofrequency ablation for small hepatocellular carcinoma. HPB (Oxford). 2021;23(4):533–537. https://doi.org/10.1016/j.hpb.2020.08.009

    Article  PubMed  Google Scholar 

  8. Yamashita YI, Imai K, Kaida T, Yamao T, Tsukamoto M, Nakagawa S, et al. 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. Surg Endosc. 2019;33(1):46–51. https://doi.org/10.1007/s00464-018-6264-3

    Article  PubMed  Google Scholar 

  9. Xu H, Zhou L, Jin Q. The effects of ultrasound-guided radiofrequency ablation and laparoscopic hepatectomy in the treatment of small hepatocellular carcinoma: a retrospective analysis. Transl Cancer Res. 2021;10(11):4794–4801. https://doi.org/10.21037/tcr-21-367

    Article  PubMed  PubMed Central  Google Scholar 

  10. Wu D, Yang Y, Chen J, Cai H, Duan Y, Sun D. Three different ways of treating primary hepatocellular carcinoma at an early stage: a prospective comparative study. Gastroenterol Res Pract. 2020;2020:7802498. https://doi.org/10.1155/2020/7802498

    Article  PubMed  PubMed Central  Google Scholar 

  11. Austin PC. The use of propensity score methods with survival or time-to-event outcomes: reporting measures of effect similar to those used in randomized experiments. Stat Med. 2014;33(7):1242–1258. https://doi.org/10.1002/sim.5984

    Article  PubMed  Google Scholar 

  12. Lonjon G, Boutron I, Trinquart L, Ahmad N, Aim F, Nizard R, et al. Comparison of treatment effect estimates from prospective nonrandomized studies with propensity score analysis and randomized controlled trials of surgical procedures. Ann Surg. 2014;259(1):18–25. https://doi.org/10.1097/SLA.0000000000000256

    Article  PubMed  Google Scholar 

  13. Zhu F, Chang Q, Duan S, Leng W. Efficacy and safety of radiofrequency ablation versus laparoscopic hepatectomy for small hepatocellular carcinoma: a protocol for a randomized controlled trial. Medicine (Baltimore). 2021;100(1): e23678. https://doi.org/10.1097/MD.0000000000023678

    Article  CAS  PubMed  Google Scholar 

  14. Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372: n71. https://doi.org/10.1136/bmj.n71

    Article  PubMed  PubMed Central  Google Scholar 

  15. Harada N, Maeda T, Yoshizumi T, Ikeda T, Kayashima H, Ikegami T, et al. Laparoscopic liver resection is a feasible treatment for patients with hepatocellular carcinoma and portal hypertension. Anticancer Res. 2016;36(7):3489–3497

    CAS  PubMed  Google Scholar 

  16. Ito T, Tanaka S, Iwai S, Takemura S, Hagihara A, Uchida-Kobayashi S, et al. Outcomes of laparoscopic hepatic resection versus percutaneous radiofrequency ablation for hepatocellular carcinoma located at the liver surface: a case-control study with propensity score matching. Hepatol Res. 2016;46(6):565–574. https://doi.org/10.1111/hepr.12592

    Article  PubMed  Google Scholar 

  17. Ko SE, Lee MW, Ahn S, Rhim H, Kang TW, Song KD, et al. Laparoscopic hepatic resection versus laparoscopic radiofrequency ablation for subcapsular hepatocellular carcinomas smaller than 3 cm: analysis of treatment outcomes using propensity score matching. Korean J Radiol. 2022;23(6):615–624. https://doi.org/10.3348/kjr.2021.0786

    Article  PubMed  PubMed Central  Google Scholar 

  18. Cheng KC, Ho KM. Pure laparoscopic liver resection versus percutaneous radiofrequency ablation for small hepatocellular carcinoma: a propensity score and multivariate analysis. Transl Cancer Res. 2022;11(1):43–51. https://doi.org/10.21037/tcr-21-1045

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Di Sandro S, Benuzzi L, Lauterio A, Botta F, De Carlis R, Najjar M, et al. Single hepatocellular carcinoma approached by curative-intent treatment: a propensity score analysis comparing radiofrequency ablation and liver resection. Eur J Surg Oncol. 2019;45(9):1691–1699. https://doi.org/10.1016/j.ejso.2019.04.023

    Article  PubMed  Google Scholar 

  20. Kim S, Yoon CJ, Cho JY, Han HS, Yoon YS, Lee HW, et al. Comparative long-term outcomes of laparoscopic hepatectomy and radiofrequency ablation for hepatocellular carcinoma located in the anterolateral segments of the liver. J Hepatobil Pancreat Sci. 2022;29(3):349–358. https://doi.org/10.1002/jhbp.1064

    Article  Google Scholar 

  21. Lee DH, Kim JW, Lee JM, Kim JM, Lee MW, Rhim H, et al. Laparoscopic liver resection versus percutaneous radiofrequency ablation for small single nodular hepatocellular carcinoma: comparison of treatment outcomes. Liver Cancer. 2021;10(1):25–37. https://doi.org/10.1159/000510909

    Article  PubMed  PubMed Central  Google Scholar 

  22. Song J, Wang Y, Ma K, Zheng S, Bie P, Xia F, et al. Laparoscopic hepatectomy versus radiofrequency ablation for minimally invasive treatment of single, small hepatocellular carcinomas. Surg Endosc. 2016;30(10):4249–4257. https://doi.org/10.1007/s00464-015-4737-1

    Article  PubMed  Google Scholar 

  23. Conticchio M, Delvecchio A, Ratti F, Gelli M, Anelli FM, Laurent A, et al. Laparoscopic surgery versus radiofrequency ablation for the treatment of single hepatocellular carcinoma ≤ 3 cm in the elderly: a propensity score matching analysis. HPB (Oxford). 2022;24(1):79–86. https://doi.org/10.1016/j.hpb.2021.05.008

    Article  PubMed  Google Scholar 

  24. Yu H. A study on propensity score matching between radiofrequency ablation and laparoscopic hepatectomy for single hepatocellular carcinoma less than 5 cm in diameter: Medical Science Center of Nanchang University; 2021. https://doi.org/10.27232/d.cnki.gnchu.2021.000643.

  25. Pan YX, Long Q, Yi MJ, Chen JB, Chen JC, Zhang YJ, et al. Radiofrequency ablation versus laparoscopic hepatectomy for hepatocellular carcinoma: a real world single center study. Eur J Surg Oncol. 2020;46(4):548–559. https://doi.org/10.1016/j.ejso.2019.10.026

    Article  PubMed  Google Scholar 

  26. Si MB, Yan PJ, Hao XY, Du ZY, Tian HW, Yang J, 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. 2019;33(8):2419–2429. https://doi.org/10.1007/s00464-019-06784-0

    Article  PubMed  Google Scholar 

  27. Li Z, Yu Q, Lu X, Liu Y, Ji B. Efficacy of radiofrequency ablation versus laparoscopic liver resection for hepatocellular carcinoma in China: a comprehensive meta-analysis. Wideochir Inne Tech Maloinwazyjne. 2021;16(3):455–471. https://doi.org/10.5114/wiitm.2021.105377

    Article  PubMed  PubMed Central  Google Scholar 

  28. Yao FY, Ferrell L, Bass NM, Watson JJ, Bacchetti P, Venook A, et al. Liver transplantation for hepatocellular carcinoma: expansion of the tumor size limits does not adversely impact survival. Hepatology. 2001;33(6):1394–1403. https://doi.org/10.1053/jhep.2001.24563

    Article  CAS  PubMed  Google Scholar 

  29. Kobe A, Kindler Y, Klotz E, Puippe G, Messmer F, Alkadhi H, et al. Fusion of preinterventional MR imaging with liver perfusion CT AFTER RFA of hepatocellular carcinoma: early quantitative prediction of local recurrence. Investig Radiol. 2021;56(3):188–196. https://doi.org/10.1097/RLI.0000000000000726

    Article  Google Scholar 

  30. Wu S, Li Z, Yao C, Dong S, Gao J, Ke S, et al. Progression of hepatocellular carcinoma after radiofrequency ablation: current status of research. Front Oncol. 2022;12:1032746. https://doi.org/10.3389/fonc.2022.1032746

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  31. Lee S, Kang TW, Cha DI, Song KD, Lee MW, Rhim H, et al. Radiofrequency ablation vs. surgery for perivascular hepatocellular carcinoma: propensity score analyses of long-term outcomes. J Hepatol. 2018;69(1):70–78. https://doi.org/10.1016/j.jhep.2018.02.026

    Article  CAS  PubMed  Google Scholar 

  32. Yin Z, Jin H, Ma T, Zhou Y, Yu M, Jian Z. A meta-analysis of long-term survival outcomes between surgical resection and radiofrequency ablation in patients with single hepatocellular carcinoma ≤ 2 cm (BCLC very early stage). Int J Surg. 2018;56:61–67. https://doi.org/10.1016/j.ijsu.2018.04.048

    Article  PubMed  Google Scholar 

  33. Liu PH, Hsu CY, Hsia CY, Lee YH, Huang YH, Chiou YY, et al. Surgical resection versus radiofrequency ablation for single hepatocellular carcinoma ≤ 2 cm in a propensity score model. Ann Surg. 2016;263(3):538–545. https://doi.org/10.1097/SLA.0000000000001178

    Article  PubMed  Google Scholar 

  34. Damm R, Zorkler I, Rogits B, Hass P, Omari J, Powerski M, et al. Needle track seeding in hepatocellular carcinoma after local ablation by high-dose-rate brachytherapy: a retrospective study of 588 catheter placements. J Contemp Brachyther. 2018;10(6):516–521. https://doi.org/10.5114/jcb.2018.80626

    Article  Google Scholar 

  35. Huang J, Yan L, Cheng Z, Wu H, Du L, Wang J, et al. A randomized trial comparing radiofrequency ablation and surgical resection for HCC conforming to the Milan criteria. Ann Surg. 2010;252(6):903–912. https://doi.org/10.1097/SLA.0b013e3181efc656

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

This work was supported by Natural Science Foundation of Fujian Province (Grant no. 2022J011300), Key Clinical Specialty Discipline Construction Program of Fuzhou, Fujian, P.R.C (Grant no. 20220301), and Science and Technology Programme of Fuzhou First Hospital (Grant no. 2022-YJ-01).

Funding

This study was funded by Natural Science Foundation of Fujian Province (Grant no. 2022J011300), Key Clinical Specialty Discipline Construction Program of Fuzhou, Fujian, P.R.C (Grant no. 20220301), and Science and Technology Programme of Fuzhou First Hospital (Grant no. 2022-YJ-01).

Author information

Author notes

  1. Wen Chen, Xiaodan Lin and Zhenheng Wu equally contributed to this work.

Authors and Affiliations

  1. Department of Hepatobiliary Surgery, Fuzhou First Hospital Affiliated with Fujian Medical University, Fuzhou, 350009, China

    Wen Chen

  2. Department of Laboratory Medicine, Fuzhou First Hospital Affiliated with Fujian Medical University, Fuzhou, 350009, China

    Xiaodan Lin

  3. Department of Hepatobiliary Surgery and Fujian Institute of Hepatobiliary Surgery, Fujian Medical University Union Hospital, 29 Xinquan Road, Fuzhou, 350001, China

    Wen Chen, Zhenheng Wu, Wei Pan, Qiming Ke & Yanling Chen

  4. Fujian Medical University Cancer Center, 1 Xueyuan Road, Minhou, Fuzhou, 350108, China

    Yanling Chen

Authors
  1. Wen Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Xiaodan Lin
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Zhenheng Wu
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Wei Pan
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Qiming Ke
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Yanling Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

YC contributed to the conception of the study; WC and XL performed the data analyses and wrote the manuscript; ZW, PW, and QK helped perform the analysis with constructive discussions.

Corresponding author

Correspondence to Yanling Chen.

Ethics declarations

Conflict of interest

The authors have no relevant financial or non-financial interests to disclose.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Chen, W., Lin, X., Wu, Z. et al. Laparoscopic liver resection is superior to radiofrequency ablation for small hepatocellular carcinoma: a systematic review and meta-analysis of propensity score-matched studies. Hepatol Int 18, 998–1010 (2024). https://doi.org/10.1007/s12072-024-10645-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12072-024-10645-x

Keywords

Search

Navigation