Radiofrequency Ablation Versus Repeat Hepatectomy for Recurrent Hepatocellular Carcinoma: A Systematic Review and Meta‐Analysis

Abstract

Background An updated systematic review and meta‐analysis was conducted to compare radiofrequency ablation (RFA) versus repeat hepatectomy (RH) for patients with recurrent hepatocellular carcinoma (rHCC) after a previous liver resection. Methods PubMed, EMBASE, and Cochrane databases were searched from inception to October 2021 for randomized controlled trials and propensity‐score matched studies. Individual participant survival data of disease‐free survival (DFS) and overall survival (OS) were extracted and reconstructed followed by one‐stage and two‐stage meta‐analysis. Secondary outcomes were major complications and length of hospital stay (LOHS). Results A total of seven studies (1317 patients) were analysed. In both one‐stage and two‐stage meta‐analysis, there was no significant difference in OS between the RFA and RH cohorts (Hazard Ratio (HR) 1.15, 95% CI 0.98–1.36, P = 0.094 and HR 1.12, 95% CI 0.77–1.64, P = 0.474 respectively), while the RFA group had a higher hazard rate of disease recurrence compared to the RH group (HR 1.30, 95% CI 1.13–1.50, P < 0.001 and HR 1.31, 95% CI 1.09–1.57, P = 0.013, respectively). RFA was associated with fewer major complications and shorter LOHS versus RH (Odds Ratio 0.34, 95% CI 0.15–0.76, P = 0.009 and Weighted Mean Difference − 4.78, 95% CI − 6.30 to − 3.26, P < 0.001, respectively). Conclusions RH may be associated with superior DFS for rHCC, at the expense of higher morbidity rate and longer LOHS. However, OS is comparable between both modalities. As such, these techniques may be utilized as complementary strategies depending on individual patient and disease factors. Large‐scale, randomized, prospective studies are required to corroborate these findings.

Role of Interventional Radiology in Management of Hepatocellular Carcinoma: Systematic Review

“…This study comprised 13 papers with a significant number of patients with hepatoma who were diagnosed and treated using various interventional radiology techniques. In terms of the study designs, Sex studies were systematic reviews [12][13][14][15][16][17], two were randomized controlled [18,19], one was a casecontrol study [20], one was a prospective study [7], two were retrospective studies [21,22] and one pilot study [23]. The purpose of this study was to assess overall survival (OS) and local recurrence (LR) after radiofrequency ablation (RFA), microwave ablation (MWA), and cryoablation (CA) for very early and early hepatocellular carcinoma (HCC).…”

Effectiveness and Safety of Radiofrequency Ablation versus Liver Resection in the Treatment of Early-stage Hepatocellular Carcinoma: A Systematic Review and Meta-analysis

“…In recent years, radiofrequency ablation has gained increasing recognition as a viable treatment option for early hepatocellular carcinoma, particularly for patients who are not candidates for liver transplantation or hepatectomy. Even for those eligible for liver transplantation or hepatectomy, radiofrequency ablation remains a safe and effective alternative, offering distinct advantages in terms of safety, costeffectiveness, minimally invasive nature, and repeatability [7]. Both radiofrequency ablation and hepatectomy can be considered as first-line treatment options when the diameter of liver cancer is less than 3 cm.…”