CLC number: R605
On-line Access: 2016-03-07
Received: 2015-12-20
Revision Accepted: 2016-02-13
Crosschecked: 2016-02-19
Cited: 2
Clicked: 4636
Chong Lai, Ren-an Jin, Xiao Liang, Xiu-jun Cai. Comparison of laparoscopic hepatectomy, percutaneous radiofrequency ablation and open hepatectomy in the treatment of small hepatocellular carcinoma[J]. Journal of Zhejiang University Science B, 2016, 17(3): 236-246.
@article{title="Comparison of laparoscopic hepatectomy, percutaneous radiofrequency ablation and open hepatectomy in the treatment of small hepatocellular carcinoma",
author="Chong Lai, Ren-an Jin, Xiao Liang, Xiu-jun Cai",
journal="Journal of Zhejiang University Science B",
volume="17",
number="3",
pages="236-246",
year="2016",
publisher="Zhejiang University Press & Springer",
doi="10.1631/jzus.B1500322"
}
%0 Journal Article
%T Comparison of laparoscopic hepatectomy, percutaneous radiofrequency ablation and open hepatectomy in the treatment of small hepatocellular carcinoma
%A Chong Lai
%A Ren-an Jin
%A Xiao Liang
%A Xiu-jun Cai
%J Journal of Zhejiang University SCIENCE B
%V 17
%N 3
%P 236-246
%@ 1673-1581
%D 2016
%I Zhejiang University Press & Springer
%DOI 10.1631/jzus.B1500322
TY - JOUR
T1 - Comparison of laparoscopic hepatectomy, percutaneous radiofrequency ablation and open hepatectomy in the treatment of small hepatocellular carcinoma
A1 - Chong Lai
A1 - Ren-an Jin
A1 - Xiao Liang
A1 - Xiu-jun Cai
J0 - Journal of Zhejiang University Science B
VL - 17
IS - 3
SP - 236
EP - 246
%@ 1673-1581
Y1 - 2016
PB - Zhejiang University Press & Springer
ER -
DOI - 10.1631/jzus.B1500322
Abstract: Objective: Three mainstream techniques—laparoscopic hepatectomy (LH), percutaneous radiofrequency ablation (pRFA), and open hepatectomy (OH)—were compared in this study, in terms of their efficacies in the treatment of small hepatocellular carcinoma (HCC). Methods: A comparative study was performed within a total of 94 patients diagnosed with small HCC in our hospital from 2005 to 2010, who underwent LH (28), RFA (33), or OH (33). They had either a single tumor lesion of less than or up to three nodules with diameters of less than each. Outcomes were carefully evaluated throughout a 3-year follow-up interval and statistically interpreted. Results: The pRFA group had a significantly lower disease-free survival rate compared with the two surgical groups (P=0.001) and significantly shorter overall survival (P=0.005), while the LH group and the OH group had no difference in survival results. For patients younger than 60 years old, surgical approaches offered a better long-term overall survival prognosis (P=0.008). There were no statistically significant differences among the three groups in overall survival for elderly patients (P=0.104). Conclusions: Among patients with small HCC, LH may provide better curative effects than pRFA without increasing complication rates. pRFA leads to faster recurrence than surgical resections. LH has similar therapeutic effects to OH and causes less trauma. For patients younger than 60 years old, LH may be the best curative treatment. Elderly patients may choose either surgery or pRFA.
[1]Asham, E.H., Kaseb, A., Ghobrial, R.M., 2013. Management of hepatocellular carcinoma. Surg. Clin. North Am., 93(6):1423-1450.
[2]Ayav, A., Germain, A., Marchal, F., et al., 2010. Radiofrequency ablation of unresectable liver tumors: factors associated with incomplete ablation or local recurrence. Am. J. Surg., 200(4):435-439.
[3]Benvegnù, L., Gios, M., Boccato, S., et al., 2004. Natural history of compensated viral cirrhosis: a prospective study on the incidence and hierarchy of major complications. Gut, 53(5):744-749.
[4]Fang, Y., Chen, W., Liang, X., et al., 2014. Comparison of long-term effectiveness and complications of radiofrequency ablation with hepatectomy for small hepatocellular carcinoma. J. Gastroenterol. Hepatol., 29(1):193-200.
[5]Fattovich, G., Stroffolini, T., Zagni, I., et al., 2004. Hepatocellular carcinoma in cirrhosis: incidence and risk factors. Gastroenterology, 127(5):S35-S50.
[6]Feng, Q., Chi, Y., Liu, Y., et al., 2015. Efficacy and safety of percutaneous radiofrequency ablation versus surgical resection for small hepatocellular carcinoma: a meta-analysis of 23 studies. J. Cancer Res. Clin. Oncol., 141(1):1-9.
[7]Feng, Z., 2013. Minshan Chen: combination of TACE and RFA can improve the treatment of HCC. Ann. Transl. Med., 1(1):10.
[8]Gu, L., Liu, H., Fan, L., et al., 2014. Treatment outcomes of transcatheter arterial chemoembolization combined with local ablative therapy versus monotherapy in hepatocellular carcinoma: a meta-analysis. J. Cancer Res. Clin. Oncol., 140(2):199-210.
[9]Kim, Y.S., Lee, W.J., Rhim, H., et al., 2010. The minimal ablative margin of radiofrequency ablation of hepatocellular carcinoma (>2 and <5 cm) needed to prevent local tumor progression: 3D quantitative assessment using CT image fusion. Am. J. Roentgenol., 195(3):758-765.
[10]Koffron, A.J., Auffenberg, G., Kung, R., et al., 2007. Evaluation of 300 minimally invasive liver resections at a single institution: less is more. Ann. Surg., 246(3):385-394.
[11]Lai, E.C.H., Tang, C.N., 2013. Radiofrequency ablation versus hepatic resection for hepatocellular carcinoma within the milan criteria—a comparative study. Int. J. Surg., 11(1):77-80.
[12]Lai, Q., Avolio, A.W., Lerut, J., et al., 2012. Recurrence of hepatocellular cancer after liver transplantation: the role of primary resection and salvage transplantation in east and west. J. Hepatol., 57(5):974-979.
[13]Liu, Z., Gao, F., Yang, G., et al., 2014. Combination of radiofrequency ablation with transarterial chemoembolization for hepatocellular carcinoma: an up-to-date meta-analysis. Tumour Biol., 35(8):7407-7413.
[14]Mulier, S., Ni, Y.C., Jamart, J., et al., 2005. Local recurrence after hepatic radiofrequency coagulation: multivariate meta-analysis and review of contributing factors. Ann. Surg., 242(2):158-171.
[15]Pearce, N.W., Di Fabio, F., Teng, M.J., et al., 2011. Laparoscopic right hepatectomy: a challenging, but feasible, safe and efficient procedure. Am. J. Surg., 202(5):e52-e58.
[16]Rao, A., Rao, G., Ahmed, I., 2012. Laparoscopic or open liver resection Let systematic review decide it. Am. J. Surg., 204(2):222-231.
[17]Santambrogio, R., Podda, M., Zuin, M., et al., 2003. Safety and efficacy of laparoscopic radiofrequency of hepatocellular carcinoma in patients with liver cirrhosis. Surg. Endosc. Other Interv. Tech., 17(11):1826-1832.
[18]Song, J., Wang, Y., Ma, K., et al., 2015. Laparoscopic hepatectomy versus radiofrequency ablation for minimally invasive treatment of single, small hepatocellular carcinomas. Surg. Endosc., online.
[19]Tanaka, M., Katayama, F., Kato, H., et al., 2011. Hepatitis B and C virus infection and hepatocellular carcinoma in china: a review of epidemiology and control measures. J. Epidemiol., 21(6):401-416.
[20]Verslype, C., van Cutsem, E., Dicato, M., et al., 2009. The management of hepatocellular carcinoma. Current expert opinion and recommendations derived from the 10th world congress on gastrointestinal cancer, barcelona, 2008. Ann. Oncol., 20(Suppl. 7):vii1-vii6.
[21]Zhu, A.X., 2012. Molecularly targeted therapy for advanced hepatocellular carcinoma in 2012: current status and future perspectives. Semin. Oncol., 39(4):493-502.
Open peer comments: Debate/Discuss/Question/Opinion
<1>