title: Minimally invasive surgery versus percutaneous radio frequency ablation for the treatment of single small (≤3 cm) hepatocellular carcinoma: a case-control study.
abstract: Patients with single small hepatocellular carcinoma (HCC) can be managed by surgical resection or radio frequency ablation (RFA), with similar recurrence and survival rates. Recently, minimally invasive surgery (MIS) has been introduced in liver surgery, and the advantage/drawback balance between surgery and RFA needs reassessment.
  
  
  
  Patients with Child-Pugh class A or B cirrhosis, and with single 1-3 cm HCC, undergoing MIS (laparoscopic or robot-assisted) or RFA from July 1998 to December 2012 were compared.
  
  
  
  Overall, 45 patients underwent MIS, and 60 underwent RFA. Groups were not statistically different regarding type of underlying liver disease, HCC size, and AFP. However, RFA patients showed worse liver synthetic function with lower albumin and higher bilirubin serum levels, and higher ASA scores. Patients with HCC in segments 2-6 were more often treated by MIS. The incidence of complications was similar between groups (RFA: 6/60, 10 % vs. MIS: 5/45, 11 %, p = 0.854), and there was no measurable difference in the rate of procedure-related blood transfusions (RFA: 1/60, 1.7 % vs. MIS: 3/45, 6.7 %, p = 0.185). Local recurrence was only detected after RFA (11.7 %, p = 0.056, log-rank). Overall survival was higher in the MIS group (p = 0.042), with median survivals of 100 ± 13.5 versus 68 ± 15.9 months.
  
  
  
  The present data need further validation. Selected patients with single ≤3-cm HCCs can be safely treated by MIS, without increased risk of perioperative complication, and with a lower risk of local recurrence. MIS should be especially favoured in patients with peripheral HCCs in segments 2-6, and/or when a histological assessment is desirable.
authors.affiliation: Divisions of Transplant and Abdominal Surgery, Department of Surgery, University of Geneva Hospitals, Rue Gabrielle-Perret-Gentil, 1211, Geneva, Switzerland. giuliocesare.vitali@gmail.com.
authors.forename: Giulio C
authors.initials: GC
authors.lastname: Vitali
authors.affiliation: Department of Hepato-Biliary Surgery and Liver Transplantation, Hôpital Henri Mondor, Créteil, France.
authors.forename: Alexis
authors.initials: A
authors.lastname: Laurent
authors.affiliation: Department of Radiology, University of Geneva Hospitals, Geneva, Switzerland.|Hepato-Pancreato-Biliary Centre, University of Geneva Hospitals, Geneva, Switzerland.
authors.forename: Sylvain
authors.initials: S
authors.lastname: Terraz
authors.affiliation: Divisions of Transplant and Abdominal Surgery, Department of Surgery, University of Geneva Hospitals, Rue Gabrielle-Perret-Gentil, 1211, Geneva, Switzerland.|Hepato-Pancreato-Biliary Centre, University of Geneva Hospitals, Geneva, Switzerland.
authors.forename: Pietro
authors.initials: P
authors.lastname: Majno
authors.affiliation: Divisions of Transplant and Abdominal Surgery, Department of Surgery, University of Geneva Hospitals, Rue Gabrielle-Perret-Gentil, 1211, Geneva, Switzerland.
authors.forename: Nicolas C
authors.initials: NC
authors.lastname: Buchs
authors.affiliation: Hepato-Pancreato-Biliary Centre, University of Geneva Hospitals, Geneva, Switzerland.|Division of Clinical Pathology, University of Geneva Hospitals, Geneva, Switzerland.
authors.forename: Laura
authors.initials: L
authors.lastname: Rubbia-Brandt
authors.affiliation: Department of Radiology, Hôpital Henri Mondor, Créteil, France.
authors.forename: Alain
authors.initials: A
authors.lastname: Luciani
authors.affiliation: Department of Pathology, Hôpital Henri Mondor, Créteil, France.
authors.forename: Julien
authors.initials: J
authors.lastname: Calderaro
authors.affiliation: Divisions of Transplant and Abdominal Surgery, Department of Surgery, University of Geneva Hospitals, Rue Gabrielle-Perret-Gentil, 1211, Geneva, Switzerland.|Hepato-Pancreato-Biliary Centre, University of Geneva Hospitals, Geneva, Switzerland.
authors.forename: Philippe
authors.initials: P
authors.lastname: Morel
authors.affiliation: Department of Hepato-Biliary Surgery and Liver Transplantation, Hôpital Henri Mondor, Créteil, France.
authors.forename: Daniel
authors.initials: D
authors.lastname: Azoulay
authors.affiliation: Divisions of Transplant and Abdominal Surgery, Department of Surgery, University of Geneva Hospitals, Rue Gabrielle-Perret-Gentil, 1211, Geneva, Switzerland. christian.toso@hcuge.ch.|Hepato-Pancreato-Biliary Centre, University of Geneva Hospitals, Geneva, Switzerland. christian.toso@hcuge.ch.
authors.forename: Christian
authors.initials: C
authors.lastname: Toso
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000601:surgery*; D016022:Case-Control Studies; D017115:Catheter Ablation / Q000401:mortality; D005260:Female; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D053208:Kaplan-Meier Estimate; D010535:Laparoscopy; D008103:Liver Cirrhosis / Q000601:surgery; D008113:Liver Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D009364:Neoplasm Recurrence, Local; D015996:Survival Rate
keywords: Hepatocellular carcinoma; Laparoscopy; Liver; Outcome; Resection; Robot