Radiofrequency ablation versus surgical resection in elderly patients with early-stage hepatocellular carcinoma in the era of organ shortage

Abstract

Background/Aims:To compare the survival benefits of surgical resection (SR) with those of radiofrequency ablation (RFA) in elderly patients (≥65 years) with single hepatocellular carcinoma (HCC) ≤5 cm.Patients and Methods:Using the Surveillance, Epidemiology, and End Results database, a total of 461 patients who underwent SR and 575 patients who underwent RFA were enrolled from 2004 to 2012. Overall survival (OS) and liver-cancer-specific survival (LCSS) comparisons were conducted between the two groups before and after propensity score matching (PSM).Results:Elderly patients with early-stage HCC had a lower rate of utilization of liver transplantation, and they were more likely to receive SR or RFA as their first-line treatment compared with younger patients (P < 0.05). In the whole cohort, the SR group had significantly better OS [RFA, hazard ratio (HR) = 1.680 (1.390, 2.031), P < 0.001] and LCSS (RFA, HR = 1.658 (1.327, 2.070), P < 0.001) than the RFA group. After PSM, the improved survival in the SR group was further confirmed (all P < 0.001). In the subgroup analyses, according to patients' age (65–75, >75 years) and tumor size (≤3.0, 3.1–5.0 cm), the SR group still presented better OS and LCSS than the RFA group (all P < 0.05), except for those older than 75 years with tumors ≤3.0 cm (all P > 0.05), both before and after PSM.Conclusion:Treatment strategies for elderly patients (≥65 years) with single HCC ≤5 cm should emphasize SR as the primary therapy, while RFA can be an alternative to SR for those >75 years with single HCC ≤3 cm.

Do Elderly Patients With Stage I–II Hepatocellular Carcinoma Benefit From More Radical Surgeries? A Population-Based Analysis

“…However, there are also some drawbacks that need to be noticed. In fact, there is a lot of information that is unavailable in SEER but is closely correlated with post-operative survival, such as the details of the surgery, laboratory results, postoperational radiation, and systemic chemotherapy, as well as the performance status and severity of dysfunction of the liver or other organs (7,16,20,24). Although the fibrosis score is provided, it is not sufficient to estimate the severity of cirrhosis.…”

“…It is also undetermined whether these elderly patients benefit substantially more from the more radical surgical therapies, e.g., hemihepatectomy or liver transplantation, compared with the less invasive surgeries, such as radio-frequency ablation or segmental liver resection. For the present, there are few studies that investigate this issue with convincing and dependable hugescale data such as ours (6,7).…”

Is the treatment outcome of hepatocellular carcinoma inferior in elderly patients?

“…In the comparison of RFA and surgical resection by postoperative outcomes, contradictory results were yielded. Peng et al[73] reported that patients having RFA had better outcomes than those having surgical resection, while Bauschke et al[74] and Yu et al[75] reported better outcomes for surgical resection. Another retrospective study by Jiang et al[76] concluded that RFA should be recommended for elderly patients (age > 65 years) with HCCs ≤ 20 mm while surgical resection would be a better treatment for HCCs of 21-50 mm in elderly patients.…”

Endoscopic salvage treatment of histoacryl after stent application on the anastomotic leak after gastrectomy: A case report

“…Anastomotic leakage following gastrectomy for gastric cancer is a life-threatening complication, and revisional surgery has a high mortality rate. The treatment includes conservative management, endoscopic treatment, and surgery[ 5 ]. Surgery is generally recommended for patients in critical condition.…”