Selecting treatment for hepatocellular carcinoma based on the results of hepatic resection and local ablation therapy.
BACKGROUND
First-line treatment for <or=3 hepatocellular carcinomas (HCCs) <or=3 cm in size remains controversial. The superiority of survival benefit needs to be clarified between these modalities for such lesions.


METHODS
We examined post-treatment survival of 144 consecutive HCC patients who underwent hepatectomy and of 56 consecutive HCC patients who underwent thermal ablation therapy limited to the HCC (<or=3 cm, <or=3 lesions).


RESULTS
Pretreatment liver function was significantly worse and prevalence of Child-Pugh classification B/C was significantly higher in the ablation group compared to the hepatectomy group. Prevalence of tumor recurrence after treatment did not differ significantly between groups, irrespective of solitary or multiple HCC. In solitary HCC, overall survival rates in both groups did not differ significantly. Even in Child-Pugh B patients, survival was not significantly different between hepatectomy and ablation. In HCC with 2-3 lesions <or=3 cm, overall survival was significantly longer with hepatectomy than with ablation and mean survival periods in the hepatectomy and ablation groups were 4.5 and 1.2 years, respectively.


CONCLUSIONS
In cases of multiple small HCCs, hepatic resection is recommended over local ablation therapy as the first-line treatment in cases where liver function has been preserved.
Nanashima
Atsushi
A
Division of Surgical Oncology, Nagasaki University Hospital, Nagasaki, Japan. a-nanasm@nagasaki-u.ac.jp
Tobinaga
Syuuichi
S
Masuda
Junichi
J
Miyaaki
Hisamitsu
H
Taura
Naota
N
Takeshita
Hiroaki
H
Hidaka
Shigekazu
S
Sawai
Terumitsu
T
Nakao
Kazuhiko
K
Nagayasu
Takeshi
T
D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods; D005260:Female; D006498:Hepatectomy; D006801:Humans; D008111:Liver Function Tests; D008113:Liver Neoplasms / Q000401:mortality / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local