title: Laparoscopic ablation therapies or hepatic resection in cirrhotic patients with small hepatocellular carcinoma.
abstract: BACKGROUND
  The Barcelona Clinic Liver Cancer staging system recommends radiofrequency ablation as treatment of choice for patients with "small" (up to 2 cm in size) hepatocellular carcinoma.
  
  
  OBJECTIVE
  Aim of the study was to assess whether laparoscopic ablation therapies or hepatic resection could be proposed as alternative option if percutaneous approach is not feasible.
  
  
  METHODS
  Overall survival and tumour recurrence rate were compared in a retrospective cohort of 176 consecutive patients with small hepatocellular carcinoma on cirrhosis treated by laparoscopic ablation therapies or surgery. To balance the covariates between the two groups, a propensity case-matched analysis was developed to generate a matched sample, which included 76 patients in each arm.
  
  
  RESULTS
  Local tumour progression (p=0.005), intra-segmental recurrence (p=0.0001), and 5-year recurrence rates (80% vs. 60%; p=0.0014) were significantly higher in the ablation therapies group. The 5-year survival rate were 48% after ablation therapies and 69% after hepatic resection (p=0.0006). Multivariate analysis showed that MELD score, alpha-fetoprotein value, procedure category and intraoperative restaging were associated with survival, while the surgery was the only independent predictor of intra-hepatic recurrence.
  
  
  CONCLUSIONS
  The present study suggests that, if percutaneous ablation is not feasible, hepatic resection may be considered as a sound option in the treatment of small hepatocellular carcinoma.
authors.affiliation: Surgical Unit 2, Hepatobiliary-Pancreatic and Digestive, San Paolo Hospital, University of Milan, Italy. Electronic address: rsantambrogio@mclink.it.
authors.forename: Roberto
authors.initials: R
authors.lastname: Santambrogio
authors.affiliation: Humanitas University Medicine and Humanitas Research Hospital, Rozzano, Milano, Italy.
authors.forename: Savino
authors.initials: S
authors.lastname: Bruno
authors.affiliation: Department of Digestive and Hepatobiliary Surgery and Liver Transplantation, Henri Mondor Hospital, Créteil, France; Division of Gastrointestinal and Endocrine Surgery, Columbia College of Physicians and Surgeons, New York-Presbyterian Hospital, New York, USA.
authors.forename: Michael D
authors.initials: MD
authors.lastname: Kluger
authors.affiliation: Surgical Unit 2, Hepatobiliary-Pancreatic and Digestive, San Paolo Hospital, University of Milan, Italy; Department of Digestive and Hepatobiliary Surgery and Liver Transplantation, Henri Mondor Hospital, Créteil, France.
authors.forename: Mara
authors.initials: M
authors.lastname: Costa
authors.affiliation: Department of Digestive and Hepatobiliary Surgery and Liver Transplantation, Henri Mondor Hospital, Créteil, France.
authors.forename: Juan
authors.initials: J
authors.lastname: Salceda
authors.affiliation: Department of Digestive and Hepatobiliary Surgery and Liver Transplantation, Henri Mondor Hospital, Créteil, France; Department of Oncological Abdominal Surgery, National Tumour Institute "G. Pascale", Naples, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Belli
authors.affiliation: Department of Digestive and Hepatobiliary Surgery and Liver Transplantation, Henri Mondor Hospital, Créteil, France.
authors.forename: Alexis
authors.initials: A
authors.lastname: Laurent
authors.affiliation: Surgical Unit 2, Hepatobiliary-Pancreatic and Digestive, San Paolo Hospital, University of Milan, Italy.
authors.forename: Matteo
authors.initials: M
authors.lastname: Barabino
authors.affiliation: Surgical Unit 2, Hepatobiliary-Pancreatic and Digestive, San Paolo Hospital, University of Milan, Italy.
authors.forename: Enrico
authors.initials: E
authors.lastname: Opocher
authors.affiliation: Department of Digestive and Hepatobiliary Surgery and Liver Transplantation, Henri Mondor Hospital, Créteil, France.
authors.forename: Daniel
authors.initials: D
authors.lastname: Azoulay
authors.affiliation: Department of Digestive and Hepatobiliary Surgery and Liver Transplantation, Henri Mondor Hospital, Créteil, France; Hepato-Biliary Centre, AP-HP Hospital Paul Brousse, Villejuif, France.
authors.forename: Daniel
authors.initials: D
authors.lastname: Cherqui
mesh_terms: D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000150:complications / Q000378:metabolism / Q000473:pathology / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods*; D018572:Disease-Free Survival; D005260:Female; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000379:methods; D008103:Liver Cirrhosis / Q000150:complications; D008113:Liver Neoplasms / Q000150:complications / Q000378:metabolism / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome; D047368:Tumor Burden; D000509:alpha-Fetoproteins / Q000378:metabolism
chemical_list: D000509:alpha-Fetoproteins
keywords: Hepatic resection; Hepatocellular carcinoma; Laparoscopic ablation therapies; Liver cirrhosis