Surgical resection versus percutaneous radiofrequency ablation in the treatment of hepatocellular carcinoma on cirrhotic liver.
OBJECTIVE
We sought to compare the experience of 2 different surgical units in the treatment of hepatocellular carcinoma (HCC) on cirrhosis with resection or percutaneous radiofrequency ablation (RFA), respectively.


BACKGROUND
When allowed by the hepatic functional reserve, surgery is the therapy for HCC on cirrhosis; alternative treatments are proposed because of the high tumor recurrence rate after resection. RFA is being widely adopted to treat HCC.


METHODS
Over a 4-year period, 79 cirrhotics with HCC underwent resection in 1 surgical unit (group A) and another 79 had RFA at a different unit (group B). Patient selection, operative mortality, hospital stay, and 1- and 3-year overall and disease-free survival were analyzed.


RESULTS
Group A (surgery): mean follow-up was 28.9 +/- 17.9 months; operative mortality was 3.8%, mean hospital stay 9 days; 1- and 3-year survival were, respectively, 83 and 65%. One- and 3-year disease-free survival were 79 and 50%. Group B (RFA): mean follow-up was 15.6 +/- 11.7 months. Mean hospital stay was 1 day (range 1-8). One- and 3-year survival were 78 and 33%; 1- and 3-year disease-free survival were 60 and 20%. Overall and disease-free survival were significantly higher in group A (P = 0.002 and 0.001). The advantage of surgery was more evident for Child-Pugh class A patients and for single tumors of more than 3 cm in diameter. Results were similar in 2 groups for Child-Pugh class B patients


CONCLUSIONS
RFA has still to be confirmed as an alternative to surgery for potentially-resectable HCCs.
Vivarelli
Marco
M
Department of Surgery and Transplantation, University of Bologna, S. Orsola Hospital, Bologna, Italy. vivarelli@orsola-malpighi.med.unibo.it
Guglielmi
Alfredo
A
Ruzzenente
Andrea
A
Cucchetti
Alessandro
A
Bellusci
Roberto
R
Cordiano
Claudio
C
Cavallari
Antonino
A
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000150:complications / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D017115:Catheter Ablation; D018572:Disease-Free Survival; D005260:Female; D006498:Hepatectomy; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications*; D008113:Liver Neoplasms / Q000150:complications / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015996:Survival Rate