title: Could radiofrequency ablation replace liver resection for small hepatocellular carcinoma in patients with compensated cirrhosis? A 5-year follow-up.
abstract: OBJECTIVE
  Treating hepatocellular carcinoma involves many different specialists and requires multidisciplinary management. In light of the current discussion on the role of ablative therapy, the aim of this study is to compare patients who undergo hepatic resection to those treated with radiofrequency ablation.
  
  
  METHODS
  The procedures have been conducted in two institutes following the same methodologies. Ninety-six patients with Child-Pugh class A cirrhosis, single or multinodular hepatocellular carcinoma (HCC) and a diameter less than or equal to 3 cm, have been included in this retrospective study: 52 patients have been treated by surgical resection and 44 by radiofrequency ablation. Patient characteristics, survival and disease-free survival have all been analysed.
  
  
  RESULTS
  Disease-free survival was longer in the resection group in comparison to the radiofrequency group with a median disease-free time of 48 versus 34 months, respectively (P = 0.04, hazard ratio = 1.5, 95 % confidence interval = 0.9-2.5). In the resection group, median survival was 54 months with a survival rate at 1, 3 and 5 years of 100, 98 and 46.2 %. In the radiofrequency group, median survival was 40 months with 1-, 3- and 5-year survival rate of 95.5, 68.2 and 36.4 %.
  
  
  CONCLUSIONS
  The current study shows that for small HCC in the presence of compensated cirrhosis, surgical resection gives better results than radiofrequency, both in terms of overall survival, as well as disease-free survival. Further evidence is required to clarify the role of ablative therapy as a curative treatment and whether it can replace surgery.
authors.affiliation: Department of Digestive Surgery and Liver Unit, University of Perugia, St. Maria Hospital, Via Tristano di Joannuccio, Terni 05100, Italy. djdesi85@hotmail.it
authors.forename: Jacopo
authors.initials: J
authors.lastname: Desiderio
authors.forename: Stefano
authors.initials: S
authors.lastname: Trastulli
authors.forename: Rosario
authors.initials: R
authors.lastname: Pasquale
authors.forename: Davide
authors.initials: D
authors.lastname: Cavaliere
authors.forename: Roberto
authors.initials: R
authors.lastname: Cirocchi
authors.forename: Carlo
authors.initials: C
authors.lastname: Boselli
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Noya
authors.forename: Amilcare
authors.initials: A
authors.lastname: Parisi
mesh_terms: D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods*; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications* / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D012189:Retrospective Studies