Meta-analysis of the Therapeutic Effect of Hepatectomy Versus Radiofrequency Ablation for the Treatment of Hepatocellular Carcinoma

Abstract

Surgical resection has been considered to be the best treatment for hepatocellular carcinoma (HCC). However, in recent years, there has been growing interest in the therapy of radiofrequency ablation (RFA). This meta-analysis is to evaluate the therapeutic effect of those 2 therapeutic methods. Outcomes evaluated were death rate, complications, survival rates, recurrence-free survival rates, and recurrence. Primary authors were contacted to retrieve further information if necessary. There is no significant difference in death rates of the treatment of HCC in the groups of hepatectomy and RFA, although the recurrence of HCC may be lower in the hepatectomy group. In the group of RFA, the recurrence rate in the previous site was higher but was lower in the new area, whereas it seems equal in the extrahepatic area. RFA may have comparable results with surgical resection in patients in the therapeutic effect of ablation for the treatment of HCC, if recurrence of HCC after RFA could be timely detected and effectively treated.

A Recent Advance in Image-Guided Locoregional Therapy for Hepatocellular Carcinoma

“…Head-to-head comparisons between RFA and resection have been conflicting, with one randomized trial [20] demonstrating essentially no difference in overall survival (OS), and the other [9] indicating improved results for surgery over RFA. Similar conflicts are found in two meta-analyses, with one [21] showing equivalent survival rates despite higher rates of local recurrence with RFA, and the other [22] demonstrating better survival rates in surgical patients with tumor sizes ≥3 cm in diameter and equivalent rates in smaller tumors.…”

Management of hepatocellular carcinoma: an overview of major findings from meta-analyses

“…Eighteen meta-analyses compared the outcomes of RFA versus surgical resection [11, 16, 24, 27, 31, 33, 47, 61, 69, 72, 89, 97, 106, 117, 119, 127, 151, 153]. As for the OS, seven of them favored surgical resection [27, 31, 47, 61, 97, 106, 127]; four demonstrated that the OS was statistically similar between the two groups [11, 16, 119, 151]; four showed that the 1-year survival was statistically similar between the two groups, but the 5-year survival was better in surgical resection group [33, 72, 89, 117]; one found that the 1- and 5-year survival were statistically similar between the two groups, but the 3-year survival was better in surgical resection group [155]; one reported that surgical resection had better OS than RFA in the subgroup analyses of a single nodule 3–5 cm and ≤ 3 cm, but the OS was statistically similar between the two groups in the subgroup analyses of a single nodule < 2 cm and 2–3 nodules < 3 cm [24].…”

“…As for the DFS, nine of them favored surgical resection in terms of DFS/RFS at any time points [11, 27, 31, 61, 72, 89, 97, 106, 155]; three showed that the 1-year DFS was statistically similar between the two groups, but the 3- and/or 5-year DFS were better in surgical resection group than in RFA group [16, 33, 151]; one reported that surgical resection had better DFS than RFA in the subgroup analyses of a single nodule 3–5 cm and ≤ 3 cm, but the DFS was statistically similar between the two groups in the subgroup analyses of a single nodule < 2 cm and 2–3 nodules < 3 cm [24]. …”

Resection and radiofrequency ablation in the treatment of hepatocellular carcinoma: a single-center experience

“…In Asia, hepatitis B virus infection is common; in the West and Japan, hepatitis C infection is the main risk factor, as well as alcohol [1]. Although liver transplantation and surgical resection remain the gold standard, only a small percentage of patients are good candidates for these modalities [3][4][5]. Recently there has been a paradigm shift in the treatment algorithm of patients with HCC, with radiofrequency ablation (RFA) being considered an alternative to resection for small HCC [3,[6][7][8][9].…”