Laparoscopic Liver Resection versus Percutaneous Radiofrequency Ablation for Small Single Nodular Hepatocellular Carcinoma: Comparison of Treatment Outcomes

Abstract

<b><i>Background:</i></b> Treatment outcomes of laparoscopic liver resection (LLR) and percutaneous radiofrequency ablation (p-RFA) for small single hepatocellular carcinomas (HCCs) have not yet been fully compared. The aim of this study was to compare LLR and p-RFA as first-line treatment options in patients with single nodular HCCs ≤3 cm. <b><i>Methods:</i></b> From January 2014 to December 2016, a total of 566 patients with single nodular HCC ≤3 cm treated by either LLR (<i>n</i> = 251) or p-RFA (<i>n</i> = 315) were included. The recurrence-free survival (RFS) and cumulative incidence of local tumor progression (LTP) were estimated using Kaplan-Meier methods and compared using the log-rank test. Treatment outcome of 2 treatment modalities was compared in the subgroup of patients according to the tumor location. <b><i>Results:</i></b> There were no significant differences in overall survival between LLR and p-RFA (<i>p</i> = 0.160); however, 3-year RFS was demonstrated to be significantly higher after LLR (74.4%) than after p-RFA (66.0%) (<i>p</i> = 0.013), owing to its significantly lower cumulative incidence of LTP (2.1% at 3 years after LLR vs. 10.0% after p-RFA, <i>p</i> < 0.001). The complication rate of p-RFA was significantly lower than that of LLR (5.1 vs. 10.0%, <i>p</i> = 0.026). LLR also provided significantly better local tumor control than p-RFA for subscapular tumors (3-year LTP rates: 1.9 vs. 8.8%, <i>p</i> = 0.012), perivascular tumors (3-year LTP rates: 0.0 vs. 17.2%, <i>p</i> = 0.007), and tumors located in anteroinfero-lateral liver portions (3-year LTP rates: 0.0 vs. 10.7%, <i>p</i> < 0.001). However, there were no significant differences in LTP rates between LLR and p-RFA for non-subcapsular and non-perivascular tumors (<i>p</i> = 0.482) and for tumors in postero-superior liver portions (<i>p</i> = 0.380). <b><i>Conclusions:</i></b> LLR can provide significantly better local tumor control than p-RFA for small single HCCs in subcapsular, perivascular, and anteroinferolateral liver portions and thus may be the preferred treatment option for these tumors.

Outcome of No-Touch Radiofrequency Ablation for Small Hepatocellular Carcinoma: A Multicenter Clinical Trial

“…Even in recent clinical trials that compared the therapeutic efficacy of RFA with that of other treatment modalities, the reported 2-year cumulative incidence of LTP after performance of RFA with the conventional tumor puncture method ranged from 11% to 16.1% (5)(6)(7). This is higher than the typically lower than 3% LTP rate after hepatic resection (8,9).…”

No-Touch vs. Conventional Radiofrequency Ablation Using Twin Internally Cooled Wet Electrodes for Small Hepatocellular Carcinomas: A Randomized Prospective Comparative Study

“…However, although RFA is widely accepted as an effective treatment option for small HCCs in nonsurgical candidates, it has a significantly higher rate of local tumor progression (LTP) compared to surgical resection, limiting its use in patients with resectable HCCs [ 4 5 6 7 ]. Several studies have demonstrated that there are no significant differences in long-term therapeutic outcomes between RFA and surgery, albeit with high LTP in RFA [ 6 8 9 ]. However, in patients with LTP, the required number of interventional procedures for controlling recurrent tumors was significantly higher than that in patients without LTP to obtain a similar overall survival outcome [ 10 ].…”

Surgical resection versus ablation for early hepatocellular carcinoma: The debate is still open

“…9 Non-subcapsular and non-perivascular tumors or tumors located in posterosuperior liver portions showed similar local tumor progression rates between RFA and laparoscopic surgical resection. 10 Although the present study did not investigate the association of the tumor location and the recurrence, the authors demonstrated that recurrence-free survival was comparable for HCC ≤2cm. Surgical resection provides better recurrence-free survival and comparable overall survival; however, it is accompanied by higher postoperative morbidity and longer hospital stay.…”