Meta-Analysis of Repeat Hepatectomy versus Radiofrequency Ablation for Recurrence of Hepatocellular Carcinoma

Abstract

Hepatocellular carcinoma (HCC) is the most common primary hepatic malignancy and a leading cause of cancer-related death in both the developed and developing world. Recurrent HCC (rHCC) develops in a significant proportion of patients even following curative-intent resection. In the absence of a structured treatment algorithm, a number of treatment options including repeat hepatectomy (RH) and radiofrequency ablation (RFA) have been utilized in select patients with rHCC. The aim of this systematic review and meta-analysis was to compare short- and long-term outcomes of patients undergoing RHR versus RFA for rHCC. Four electronic databases were screened until September 2022. A total of 17 studies were included in the meta-analysis. Overall and disease-free survival were comparable among the two groups. Patients undergoing RH were less likely to develop a second recurrence (RR 0.89, 95% C.I. 0.81 to 0.98, p = 0.02). Overall and major morbidity were significantly increased in the RH group (RR 3.01, 95% C.I. 1.98 to 4.56, p < 0.001 and RR 3.65, 95% C.I. 2.07 to 6.43, p < 0.001, respectively), while mortality was similar between RFA and RH. The data demonstrated that RFA is a safe and efficient alternative to RH for selected patients with rHCC. Nevertheless, despite higher morbidity associated with RH, repeat resection remains the preferred treatment option whenever feasible, as it allows for better local disease control.

Impact of Liver Fibrosis Severity on Oncological Prognosis in Hepatocellular Carcinoma

“…It is not surprising that patients with LC were less inclined to opt for rehepatectomy as a treatment for recurrence owing to their diminished hepatic function. Nevertheless, the efficacy of rehepatectomy in HCC has been established in numerous studies [ 24 , 25 ]. Therefore, it is desirable to either prevent liver fibrosis from progressing or to revert the liver fibrosis back to its original state.…”

Unraveling the Significance of EPH/Ephrin Signaling in Liver Cancer: Insights into Tumor Progression and Therapeutic Implications

“…Molecular targeted therapy has revolutionized the treatment landscape for various malignancies in the last two decades [ 99 , 100 , 101 , 102 , 103 , 104 , 105 ]. CCA, a rare tumor with a poor prognosis, has recently seen the identification of novel molecular alterations, bringing forth the potential for targeted therapies [ 9 , 106 ].…”

The Emerging Role of Metformin in the Treatment of Hepatocellular Carcinoma: Is There Any Value in Repurposing Metformin for HCC Immunotherapy?

“…Whilst its incidence is anticipated to increase in the future, HCC is acknowledged as a well-known cause of death in cirrhotic patients [ 1 , 3 ]. Substantial progress has been made in understanding the risk factors and epidemiology of HCC, resulting in the implementation of efficient preventative, diagnostic and treatment strategies, which, in turn, have led to a significant impact on survival outcomes [ 2 , 4 , 5 , 6 , 7 , 8 ]. Chronic hepatitis B and C viral infections, nonalcoholic fatty liver disease and alcoholic cirrhosis constitute the leading causes of HCC, whilst other risk factors such as obesity and type 2 diabetes mellitus (T2DM) are also associated with hepatocellular carcinogenesis [ 2 , 9 , 10 ].…”