Meta-analysis of radiofrequency ablation versus hepatic resection for small hepatocellular carcinoma

Abstract

BackgroundThere is no clear consensus on the better therapy [radiofrequency ablation (RFA) versus hepatic resection (HR)] for small hepatocellular carcinoma (HCC) eligible for surgical treatments. This study is a meta-analysis of the available evidence.MethodsSystematic review and meta-analysis of trials comparing RFA with HR for small HCC published from 1997 to 2009 in PubMed and Medline. Pooled odds ratios (OR) with 95% confidence intervals (95% CI) were calculated using either the fixed effects model or random effects model.ResultsOne randomized controlled trial, and 9 nonrandomized controlled trials studies were included in this analysis. These studies included a total of 1411 patients: 744 treated with RFA and 667 treated with HR. The overall survival was significantly higher in patients treated with HR than in those treated with RFA at 3 years (OR: 0.56, 95% CI: 0.44-0.71), and at 5 year (OR: 0.60, 95% CI: 0.36-1.01). RFA has a higher rates of local intrahepatic recurrence compared to HR (OR: 4.50, 95% CI: 2.45-8.27). In the HR group the 1, 3, and 5 years disease -free survival rates were significantly better than in the HR-treated patients (respectively: OR: 0.54, 95% CI: 0.35-0.84; OR: 0.44, 95% CI: 0.28-0.68; OR: 0.64, 95% CI: 0.42-0.99). The postoperative morbidity was higher with HR (OR: 0.29, 95% CI: 0.13-0.65), but no significant differences were found concerning mortality. For tumors ≤ 3 cm HR did not differ significantly from RFA for survival, as reported in three NRCTs .ConclusionsHR was superior to RFA in the treatment of patients with small HCC eligible for surgical treatments, particularly for tumors > 3 cm. However, the findings have to be carefully interpreted due to the lower level of evidence.

Hospital volume of percutaneous radiofrequency ablation is closely associated with treatment outcomes for patients with hepatocellular carcinoma

“…However, the 5-year survival rate of 50% to 60% for the patients in this study was comparable to that of patients who underwent hepatic resection, which is available only for patients who have minimal cirrhosis and adequate liver function reserve. 31 We maintain that the majority of patients in our study were homogenous, possessed relatively preserved liver function, and received RFA with curative intent.…”

Multiple-electrode radiofrequency ablations using Octopus® electrodes in anin vivoporcine liver model

“…However, in a large number of cases, this approach requires overlapping ablations in order to create a sufficient number of safety zones around the target tumour [4][5]. In fact, the most demanding technical difficulty in performing overlapping ablations using a single electrode is related to the echogenic bubble clouds created during the RFA procedure [6] and which may result in a higher local recurrence rate than surgical resection [22,23]. We believe that RFA using the Octopus electrode may alleviate this technical problem.…”

Economic Evaluation and Budget Impact Analysis of the Surveillance Program for Hepatocellular Carcinoma in Thai Chronic Hepatitis B Patients

“…To calculate the transition probabilities, all values of average annual transition probabilities for one year-cycle length were changed to semi-annual probabilities by the survival curve function and put into six month-cycle length estimation. Transition probabilities were obtained from published studies (Lee et al, 2002;Chung, 2005;Yeung et al, 2005;Chen et al, 2006;2009;Fattovich et al, 2008;Bouza et al, 2009;Cheng et al, 2009;Kim et al, 2009;Cabibbo et al, 2010;Tong et al, 2010;Zhou et al, 2010a;2010b;Chun et al, 2011;Kao, et al, 2011;Sawhney et al, 2011;Thein et al, 2012).…”