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Minimally invasive surgery versus percutaneous radio frequency ablation for the treatment of single small (≤3 cm) hepatocellular carcinoma: a case–control study

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Abstract

Background

Patients with single small hepatocellular carcinoma (HCC) can be managed by surgical resection or radio frequency ablation (RFA), with similar recurrence and survival rates. Recently, minimally invasive surgery (MIS) has been introduced in liver surgery, and the advantage/drawback balance between surgery and RFA needs reassessment.

Methods

Patients with Child-Pugh class A or B cirrhosis, and with single 1–3 cm HCC, undergoing MIS (laparoscopic or robot-assisted) or RFA from July 1998 to December 2012 were compared.

Results

Overall, 45 patients underwent MIS, and 60 underwent RFA. Groups were not statistically different regarding type of underlying liver disease, HCC size, and AFP. However, RFA patients showed worse liver synthetic function with lower albumin and higher bilirubin serum levels, and higher ASA scores. Patients with HCC in segments 2–6 were more often treated by MIS. The incidence of complications was similar between groups (RFA: 6/60, 10 % vs. MIS: 5/45, 11 %, p = 0.854), and there was no measurable difference in the rate of procedure-related blood transfusions (RFA: 1/60, 1.7 % vs. MIS: 3/45, 6.7 %, p = 0.185). Local recurrence was only detected after RFA (11.7 %, p = 0.056, log-rank). Overall survival was higher in the MIS group (p = 0.042), with median survivals of 100 ± 13.5 versus 68 ± 15.9 months.

Conclusion

The present data need further validation. Selected patients with single ≤3-cm HCCs can be safely treated by MIS, without increased risk of perioperative complication, and with a lower risk of local recurrence. MIS should be especially favoured in patients with peripheral HCCs in segments 2–6, and/or when a histological assessment is desirable.

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Acknowledgments

Christian Toso was supported by a Professorship from the Swiss National Science Foundation (PP00P3_139021). The work was supported by the Artères Foundation.

Disclosures

Drs. Giulio C. Vitali, Alexis Laurent, Sylvain Terraz, Pietro Majno, Nicolas C. Buchs, Laura Rubbia-Brandt, Alain Luciani, Julien Calderaro, Philippe Morel, Daniel Azoulay, and Christian Toso have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Divisions of Transplant and Abdominal Surgery, Department of Surgery, University of Geneva Hospitals, Rue Gabrielle-Perret-Gentil, 1211, Geneva, Switzerland

    Giulio C. Vitali, Pietro Majno, Nicolas C. Buchs, Philippe Morel & Christian Toso

  2. Department of Hepato-Biliary Surgery and Liver Transplantation, Hôpital Henri Mondor, Créteil, France

    Alexis Laurent & Daniel Azoulay

  3. Department of Radiology, University of Geneva Hospitals, Geneva, Switzerland

    Sylvain Terraz

  4. Hepato-Pancreato-Biliary Centre, University of Geneva Hospitals, Geneva, Switzerland

    Sylvain Terraz, Pietro Majno, Laura Rubbia-Brandt, Philippe Morel & Christian Toso

  5. Division of Clinical Pathology, University of Geneva Hospitals, Geneva, Switzerland

    Laura Rubbia-Brandt

  6. Department of Radiology, Hôpital Henri Mondor, Créteil, France

    Alain Luciani

  7. Department of Pathology, Hôpital Henri Mondor, Créteil, France

    Julien Calderaro

Authors
  1. Giulio C. Vitali
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  2. Alexis Laurent
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  3. Sylvain Terraz
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  7. Alain Luciani
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  8. Julien Calderaro
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  9. Philippe Morel
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  10. Daniel Azoulay
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  11. Christian Toso
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Correspondence to Giulio C. Vitali or Christian Toso.

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Vitali, G.C., Laurent, A., Terraz, S. et al. Minimally invasive surgery versus percutaneous radio frequency ablation for the treatment of single small (≤3 cm) hepatocellular carcinoma: a case–control study. Surg Endosc 30, 2301–2307 (2016). https://doi.org/10.1007/s00464-015-4295-6

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  • DOI: https://doi.org/10.1007/s00464-015-4295-6

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