title: Is radiofrequency ablation equal to surgical re-resection for recurrent hepatocellular carcinoma meeting the Milan criteria? A meta-analysis.
abstract: OBJECTIVE
  To evaluate the clinical efficacy and safety of radiofrequency ablation (RFA) with surgical re-resection (SRR) in patients with postoperative recurrent hepatocellular carcinoma (RHCC) meeting the Milan criteria.
  
  
  METHODS
  A literature search was performed to identify comparative studies addressing outcomes of both RFA and SRR for RHCC meeting the Milan criteria. Pooled odds ratios (OR) with 95% confidence intervals (95% CI) were calculated using either the fixed effects model or the random effects model.
  
  
  RESULTS
  Five nonrandomized controlled trials were included in the analysis. These studies included a total of 543 patients: 243 treated with RFA and 300 treated with SRR. The SRR group had a better 3-year recurrence-free survival rate compared with RFA group (OR 0.44, 95%CI 0.25-0.77, p=0.004). However, there were no obvious differences between RFA and SRR group in overall survival (OS) rates, re-recurrence rate and OS rates with tumors ≤ 3cm. What's more, the RFA group had a safety advantage with less complications of Clavien classification grade II or higher compared with SRR group (OR 0.21, 95%CI 0.05-0.94, p=0.04).
  
  
  CONCLUSIONS
  RFA seemed to be superior to SRR in the treatment of patients with RHCC meeting the Milan criteria on account of clinical safety. However, these findings have to be carefully interpreted due to the lower level of evidence.
authors.affiliation: Department of Hepatobiliary Surgery and Unit of Organ Transplantation, First Affiliated Hospital, China Medical University, Shenyang, Liaoning Province, P.R. China.
authors.forename: Cheng-shuo
authors.initials: CS
authors.lastname: Zhang
authors.forename: Jia-lin
authors.initials: JL
authors.lastname: Zhang
authors.forename: Xiao-hang
authors.initials: XH
authors.lastname: Li
authors.forename: Le
authors.initials: L
authors.lastname: Li
authors.forename: Xin
authors.initials: X
authors.lastname: Li
authors.forename: Xiang-yu
authors.initials: XY
authors.lastname: Zhou
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D017115:Catheter Ablation / Q000009:adverse effects / Q000401:mortality; D016009:Chi-Square Distribution; D018572:Disease-Free Survival; D006498:Hepatectomy / Q000009:adverse effects / Q000401:mortality; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D016017:Odds Ratio; D018579:Patient Selection; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome