Efficacy and safety of percutaneous radiofrequency ablation versus surgical resection for small hepatocellular carcinoma: a meta-analysis of 23 studies

PurposeThe aim of our meta-analysis was to compare the efficacy and safety of radiofrequency ablation (RFA) versus surgical resection for patients with small hepatocellular carcinoma (SHCC).MethodsRandomized controlled trials (RCTs) or retrospective studies comparing the RFA with surgical resection for patients with SHCC published from 2004 to 2014 were selected from database of PubMed, EMBASE and Cochrane library. The outcomes including overall survival rate, recurrence-free survival rate, recurrence rate and complications (mortality rate and morbidity rate) were abstracted. Individual and pooled odds ratio with 95 % confidence interval of each outcome was analyzed.ResultsThree RCTs and twenty retrospective studies were included with a total of 15,482 patients. The 1-, 3- and 5-year overall survival rate and recurrence-free survival rate of surgical resection were significantly higher than RFA. The 2- and 3-year but not 1-year recurrence rate of RFA was significantly higher than surgical resection. The morbidity rate of complication in surgical resection group was higher than it in RFA group, but the mortality was not different between the two groups.ConclusionSurgical resection led to a higher overall survival and recurrence-free survival rate in treating SHCC. However, RFA led to a lower morbidity rate of complication than surgical resection.

[1]  Y. Miao,et al.  Meta-analysis of surgical resection and radiofrequency ablation for early hepatocellular carcinoma , 2012, World Journal of Surgical Oncology.

[2]  F. Xia,et al.  A randomized controlled trial of radiofrequency ablation and surgical resection in the treatment of small hepatocellular carcinoma. , 2012, Journal of hepatology.

[3]  Keiichi Hatamaru,et al.  Comparison of percutaneous radiofrequency thermal ablation and surgical resection for small hepatocellular carcinoma , 2011, BMC gastroenterology.

[4]  M. Abu-Hilal,et al.  Surgical Resection Versus Radiofrequency Ablation in the Treatment of Small Unifocal Hepatocellular Carcinoma , 2008, Journal of Gastrointestinal Surgery.

[5]  C. Boselli,et al.  Could radiofrequency ablation replace liver resection for small hepatocellular carcinoma in patients with compensated cirrhosis? A 5-year follow-up , 2012, Langenbeck's Archives of Surgery.

[6]  Junji Furuse,et al.  The incidence and epidemiology of hepatocellular carcinoma: a global and regional perspective. , 2010, The oncologist.

[7]  Xiaohua Liu,et al.  Clinical outcomes of radiofrequency ablation and surgical resection for small hepatocellular carcinoma: A meta‐analysis , 2012, Journal of gastroenterology and hepatology.

[8]  G. Giannelli,et al.  Single hepatocellular carcinoma ranging from 3 to 5 cm: radiofrequency ablation or resection? , 2007, HPB : the official journal of the International Hepato Pancreato Biliary Association.

[9]  Sheng-Nan Lu,et al.  Survival comparison between surgical resection and radiofrequency ablation for patients in BCLC very early/early stage hepatocellular carcinoma. , 2012, Journal of hepatology.

[10]  Osamu Matsui,et al.  Comparison of resection and ablation for hepatocellular carcinoma: a cohort study based on a Japanese nationwide survey. , 2013, Journal of hepatology.

[11]  K. Kuo,et al.  Survival comparison between surgical resection and percutaneous radiofrequency ablation for patients in Barcelona Clinic Liver Cancer early stage hepatocellular carcinoma , 2013, Indian Journal of Gastroenterology.

[12]  N. Horiike,et al.  Efficacy of radiofrequency ablation therapy compared to surgical resection in 164 patients in Japan with single hepatocellular carcinoma smaller than 3 cm, along with report of complications. , 2008, Hepato-gastroenterology.

[13]  Yoshiyuki Suzuki,et al.  Stage progression of small hepatocellular carcinoma after radical therapy: comparisons of radiofrequency ablation and surgery using the Markov model , 2011, Liver international : official journal of the International Association for the Study of the Liver.

[14]  M. D’Onofrio,et al.  Radiofrequency Ablation Versus Surgical Resection for the Treatment of Hepatocellular Carcinoma in Cirrhosis , 2007, Journal of Gastrointestinal Surgery.

[15]  A. Venook,et al.  Liver transplantation for hepatocellular carcinoma: Expansion of the tumor size limits does not adversely impact survival , 2001, Hepatology.

[16]  J. Hiatt,et al.  Surgical Resection of Hepatocellular Carcinoma , 2008, Cancer journal.

[17]  H. Rhim,et al.  Current status of radiofrequency ablation of hepatocellular carcinoma. , 2010, World journal of gastrointestinal surgery.

[18]  M. Choi,et al.  Superior long-term outcomes after surgery in child-pugh class a patients with single small hepatocellular carcinoma compared to radiofrequency ablation , 2011, Hepatology international.

[19]  A. Burroughs,et al.  Hepatocellular carcinoma , 2003, The Lancet.

[20]  Dongil Choi,et al.  Comparing the Outcomes of Radiofrequency Ablation and Surgery in Patients With a Single Small Hepatocellular Carcinoma and Well-Preserved Hepatic Function , 2005, Journal of clinical gastroenterology.

[21]  Y. Chou,et al.  Survival rates are comparable after radiofrequency ablation or surgery in patients with small hepatocellular carcinomas. , 2011, Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association.

[22]  H. Rhim,et al.  Radiofrequency ablation of hepatocellular carcinoma: pros and cons. , 2010, Gut and liver.

[23]  H. Rhim,et al.  Radiofrequency ablation versus surgical resection as primary treatment of hepatocellular carcinoma meeting the Milan criteria: A systematic review , 2011, Journal of gastroenterology and hepatology.

[24]  J. Marrero.  Multidisciplinary Management of Hepatocellular Carcinoma: Where Are We Today? , 2013, Seminars in Liver Disease.

[25]  Yong Zeng,et al.  A Randomized Trial Comparing Radiofrequency Ablation and Surgical Resection for HCC Conforming to the Milan Criteria , 2010, Annals of surgery.

[26]  Hang Bin,et al.  Prospective comparative study of cool-tip radiofrequency ablation and surgical resection for hepatocellular carcinoma , 2011 .

[27]  M. Pompili,et al.  Long-term effectiveness of resection and radiofrequency ablation for single hepatocellular carcinoma , 2013 .

[28]  H. Tsubouchi,et al.  Surgical resection versus radiofrequency ablation for small hepatocellular carcinomas within the Milan criteria. , 2009, Journal of hepato-biliary-pancreatic surgery.

[29]  Shuqun Cheng,et al.  Percutaneous Radiofrequency Ablation Versus Partial Hepatectomy for Small Centrally Located Hepatocellular Carcinoma , 2013, World Journal of Surgery.

[30]  Masatoshi Kudo,et al.  Radiofrequency Ablation for Hepatocellular Carcinoma: Updated Review in 2010 , 2010, Oncology.

[31]  T. Ishiko,et al.  Comparison between hepatic resection and radiofrequency ablation as first‐line treatment for solitary small‐sized hepatocellular carcinoma of 3 cm or less , 2013, Hepatology research : the official journal of the Japan Society of Hepatology.

[32]  Ming Shi,et al.  Radiofrequency ablation versus hepatic resection for the treatment of hepatocellular carcinomas 2 cm or smaller: a retrospective comparative study. , 2012, Radiology.

[33]  A. Tsung,et al.  Radiofrequency ablation compared to resection in early-stage hepatocellular carcinoma. , 2013, HPB : the official journal of the International Hepato Pancreato Biliary Association.

[34]  W. Lau,et al.  A Prospective Randomized Trial Comparing Percutaneous Local Ablative Therapy and Partial Hepatectomy for Small Hepatocellular Carcinoma , 2006, Annals of surgery.

[35]  Bin Li,et al.  Meta-analysis of radiofrequency ablation versus hepatic resection for small hepatocellular carcinoma , 2010, BMC gastroenterology.

[36]  F. Pruvot,et al.  Meta‐analysis: evaluation of adjuvant therapy after curative liver resection for hepatocellular carcinoma , 2003, Alimentary pharmacology & therapeutics.

[37]  H. Hidaka,et al.  [Radiofrequency ablation]. , 2001, Gan to kagaku ryoho. Cancer & chemotherapy.

[38]  Tetsu Watanabe,et al.  Transcatheter arterial chemoembolization plus radiofrequency ablation therapy for early stage hepatocellular carcinoma , 2010, Cancer.