title: Surgical resection versus laparoscopic radiofrequency ablation in patients with hepatocellular carcinoma and Child-Pugh class a liver cirrhosis.
abstract: BACKGROUND
  This study compared two homogeneous groups of patients submitted to either surgical resection (HR) or laparoscopic radiofrequency ablation (LRFA) for the treatment of hepatocellular carcinoma (HCC). When compatible with the liver functional reserve, HR remains the treatment of choice for HCC, while LRFA seems to be a promising, less invasive alternative. We thus compared HR or LRFA for short- and long-term outcomes in patients with a single HCC nodule and Child-Pugh class A liver cirrhosis.
  
  
  METHODS
  We enrolled 152 cirrhotic patients out of 372 cases consecutively evaluated for HCC. Enrolled patients with similar baseline characteristics underwent HR (n = 78) or LRFA (n = 74), in both cases with intraoperative ultrasonography, and they were then followed for similar durations (mean +/- standard deviation, 36.2 +/- 23.5 months for HR vs. 38.2 +/- 28.4 for LRFA). Outcomes included short- and long-term morbidity, HCC recurrence, and overall survival.
  
  
  RESULTS
  Short-term morbidity was far higher in the HR group while, during follow-up, HCC recurrence (mainly local) was more frequent in patients treated with LRFA. More importantly, baseline alfa-fetoprotein levels and early HCC recurrence after treatment greatly influenced overall survival, while the use of HR or LRFA did not predict it. On the other hand, HCC recurrence was found to be determined by the surgical approach and ultrasound characteristics of the tumor.
  
  
  CONCLUSIONS
  Our data were obtained from a large number of HCC cases and support similar survival rates after HR or LRFA for single HCC nodules on Child-Pugh class A liver cirrhosis, despite a marked increase in HCC recurrence rates after LRFA.
authors.affiliation: USD di Chirurgia Epato-bilio-pancreatica, Ospedale Classificato San Giuseppe, Milanocuore SpA, Milan, Italy. rsantambrogio@mclink.it
authors.forename: Roberto
authors.initials: R
authors.lastname: Santambrogio
authors.forename: Enrico
authors.initials: E
authors.lastname: Opocher
authors.forename: Massimo
authors.initials: M
authors.lastname: Zuin
authors.forename: Carlo
authors.initials: C
authors.lastname: Selmi
authors.forename: Emanuela
authors.initials: E
authors.lastname: Bertolini
authors.forename: Mara
authors.initials: M
authors.lastname: Costa
authors.forename: Matteo
authors.initials: M
authors.lastname: Conti
authors.forename: Marco
authors.initials: M
authors.lastname: Montorsi
mesh_terms: D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000473:pathology / Q000601:surgery*; D017115:Catheter Ablation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D010535:Laparoscopy; D008103:Liver Cirrhosis / Q000150:complications* / Q000473:pathology; D008113:Liver Neoplasms / Q000473:pathology / Q000601:surgery*; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000601:surgery*; D009367:Neoplasm Staging; D011379:Prognosis; D011446:Prospective Studies; D015996:Survival Rate; D016896:Treatment Outcome