Comparison of clinical efficacy between radiofrequency ablation and surgical resection for early hepatocellular carcinoma: a Meta-analysis

doi:10.3877/cma.j.issn.2095-3232.2017.04.010

Abstract

Abstract:

Objective

To compare the clinical efficacy between radiofrequency ablation (RFA) and surgical resection (SR) for early hepatocellular carcinoma (HCC).

Methods

Open published literatures related to RFA and SR for the treatment of early HCC between January 2004 and February 2017 were searched by computer from PubMed, Embase, Web of science, CNKI and Wanfang databases. The researching keywords in Chinese and English included hepatocellular carcinoma, liver cancer, hepatic carcinoma, liver neoplasms, HCC, radiofrequency ablation, ablative therapy, RFA, surgical resection and hepatectomy. The clinical data including survival rate, incidence of complication and perioperative length of hospital stay of the early HCC patients up to the standard of Milan criteria were extracted for Meta-analysis. Heterogenous studies were analyzed using random effect model, and homogenous studies were analyzed using fixed effect model.

Results

A total of 20 literatures including 4 randomized control trials and 16 retrospective studies were included in this Meta-analysis. In total, 3 849 patients with early HCC were analyzed. Among the patients, 1 946 cases underwent SR and 1 903 underwent RFA. The postoperative 3-, 5-year overall survival rate of the SR patients was significantly higher than those of the RFA patients (OR=1.09, 1.58; P<0.05). The postoperative 1-, 3-, 5-year tumor-free survival rate of the SR patients was significantly higher than those of the RFA patients (OR=1.88, 2.31, 2.14; P<0.05). The postoperative 1-, 3-, 5-year tumor recurrence rate of the SR patients was significantly lower than those of the RFA patients (OR=0.57, 0.18, 0.46; P<0.05). The incidence of postoperative complications of the SR patients was significantly higher than that of the RFA patients (OR=3.84, P<0.05). The perioperative length of hospital stay of the SR patients was significantly higher than that of the RFA patients (WMD=7.08, P<0.05).

Conclusions

For early HCC patients up to the standard of Milan criteria, the long-term survival and recurrence of SR are significantly superior to those of RFA. Nevertheless, RFA has the advantages of minimal invasion, low incidence of postoperative complications and short length of hospital stay.

Key words: Carcinoma, hepatocellular, Catheter ablation, Hepatectomy, Comparative effectiveness research

Ruiwen Cui, Shuguang Zhu, Lei Fan, Shiyang Zheng, Hua Li. Comparison of clinical efficacy between radiofrequency ablation and surgical resection for early hepatocellular carcinoma: a Meta-analysis[J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2017, 06(04): 280-284.

/ / Recommend

Add to citation manager EndNote|Ris|BibTeX

URL: https://zhgzwkssxdzzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.2095-3232.2017.04.010

https://zhgzwkssxdzzz.cma-cmc.com.cn/EN/Y2017/V06/I04/280

Figures/Tables 2

References 25

[1]	Sartorius K, Sartorius B, Aldous C, et al. Global and country underestimation of hepatocellular carcinoma (HCC) in 2012 and its implications[J]. Cancer Epidemiol, 2015, 39(3):284-290.
[2]	Mazzaferro V, Regalia E, Doci R, et al. Liver transplantation for the treatment of small hepatocellular carcinomas in patients with cirrhosis[J]. N Engl J Med, 1996, 334(11):693-699.
[3]	张洪新．肝细胞肝癌微创综合治疗的现状与展望[J/CD]．中华肝脏外科手术学电子杂志，2013，2(3):146-148.
[4]	Feng K, Yan J, Li X, et al. A randomized controlled trial of radiofrequency ablation and surgical resection in the treatment of small hepatocellular carcinoma[J]. J Hepatol, 2012, 57(4):794-802.
[5]	Huang J, Yan L, Cheng Z, et al. A randomized trial comparing radiofrequency ablation and surgical resection for HCC conforming to the Milan criteria[J]. Ann Surg, 2010, 252(6):903-912.
[6]	Chen MS, Li JQ, Zheng Y, et al. A prospective randomized trial comparing percutaneous local ablative therapy and partial hepatectomy for small hepatocellular carcinoma[J]. Ann Surg, 2006, 243(3):321-328.
[7]	吕明德，匡铭，梁力建，等．手术切除和经皮热消融治疗早期肝癌的随机对照临床研究[J]．中华医学杂志，2006，86(12):801-805.
[8]	Desiderio J, Trastulli S, Pasquale R, et al. Could radiofrequency ablation replace liver resection for small hepatocellular carcinoma in patients with compensated cirrhosis? a 5-year follow-up[J]. Langenbecks Arch Surg, 2013, 398(1):55-62.
[9]	Wong KM, Yeh ML, Chuang SC, et al. Survival comparison between surgical resection and percutaneous radiofrequency ablation for patients in Barcelona Clinic Liver Cancer early stage hepatocellular carcinoma[J]. Indian J Gastroenterol, 2013, 32(4):253-257.
[10]	Peng ZW, Lin XJ, Zhang YJ, et al. Radiofrequency ablation versus hepatic resection for the treatment of hepatocellular carcinomas 2 cm or smaller: a retrospective comparative study[J]. Radiology, 2012, 262(3):1022-1033.
[11]	Lai EC, Tang CN. Radiofrequency ablation versus hepatic resection for hepatocellular carcinoma within the Milan criteria- a comparative study [J]. Int J Surg, 2013, 11(1):77-80.
[12]	Liu PH, Hsu CY, Hsia CY, et al. Surgical resection versus radiofrequency ablation for single hepatocellular carcinoma ≤2 cm in a propensity score model[J]. Ann Surg, 2016, 263(3):538-545.
[13]	Hong SN, Lee SY, Choi MS, et al. Comparing the outcomes of radiofrequency ablation and surgery in patients with a single small hepatocellular carcinoma and well-preserved hepatic function[J]. J Clin Gastroenterol, 2005, 39(3):247-252.
[14]	Hung HH, Chiou YY, Hsia CY, et al. Survival rates are comparable after radiofrequency ablation or surgery in patients with small hepatocellular carcinomas[J]. Clin Gastroenterol Hepatol, 2011, 9(1):79-86.
[15]	Wang JH, Wang CC, Hung CH, et al. Survival comparison between surgical resection and radiofrequency ablation for patients in BCLC very early/early stage hepatocellular carcinoma[J]. J Hepatol, 2012, 56(2):412-418.
[16]	Kang TW, Kim JM, Rhim H, et al. Small hepatocellular carcinoma: radiofrequency ablation versus nonanatomic resection-propensity score analyses of long-term outcomes[J]. Radiology, 2015, 275(3):908-919.
[17]	Hocquelet A, Balageas P, Laurent C, et al. Radiofrequency ablation versus surgical resection for hepatocellular carcinoma within the Milan criteria: a study of 281 Western patients[J]. Int J Hyperthermia, 2015, 31(7):749-757.
[18]	Gory I, Fink M, Bell S, et al. Radiofrequency ablation versus resection for the treatment of early stage hepatocellular carcinoma: a multicenter Australian study[J]. Scand J Gastroenterol, 2015, 50(5):567-576.
[19]	Bu X, Ge Z, Ma J, et al. Long-term efficacy of radiofrequency ablation compared to surgical resection for the treatment of small hepatocellular carcinoma[J]. J BUON, 2015, 20(2):548-554.
[20]	Pompili M, Saviano A, de Matthaeis N, et al. Long-term effectiveness of resection and radiofrequency ablation for single hepatocellular carcinoma ≤3 cm. results of a multicenter Italian survey[J]. J Hepatol, 2013, 59(1):89-97.
[21]	Park EK, Kim HJ, Kim CY, et al. A comparison between surgical resection and radiofrequency ablation in the treatment of hepatocellular carcinoma[J]. Ann Surg Treat Res, 2014, 87(2):72-80.
[22]	Guan TP, Fang CH, Yang J, et al. A comparison between three-dimensional visualization guided hepatectomy and ultrasonography guided radiofrequency ablation in the treatment of small hepatocellular carcinoma within the milan criteria[J]. Biomed Res Int, 2016:8931732.
[23]	Vivarelli M, Guglielmi A, Ruzzenente A, et al. Surgical resection versus percutaneous radiofrequency ablation in the treatment of hepatocellular carcinoma on cirrhotic liver[J]. Ann Surg, 2004, 240(1):102-107.
[24]	Wakai T, Shirai Y, Suda T, et al. Long-term outcomes of hepatectomy vs percutaneous ablation for treatment of hepatocellular carcinoma < or =4 cm[J]. World J Gastroenterol, 2006, 12(4):546-552.
[25]	何坤，胡泽民，余元龙，等．精准肝切除在原发性肝癌中的应用[J/CD]．中华肝脏外科手术学电子杂志，2016，5(2):81-85.

Please choose a citation manager

Content to export