title: Laparoscopic resectionvslaparoscopic radiofrequency ablation for the treatment of small hepatocellular carcinomas: A single-center analysis.
abstract: OBJECTIVE
  To compare survival and recurrence after laparoscopic liver resection (LLR) and laparoscopic radiofrequency ablation (LRFA) for the treatment of small hepatocellular carcinoma (HCC).
  
  
  METHODS
  Between June 1, 2005 and November 30, 2010, 46 patients (62.26 ± 8.55 years old; female/male: 12/34) treated for small HCC were enrolled following strict criteria. Patients with better liver function and larger tumors were referred for LLR (n= 24), while those with poorer liver function and multiple tumors were referred for LRFA (n= 22), and they were then followed for similar durations (44.74 ± 21.3 mo for LLRvs40.27 ± 30.8 mo for LRFA).
  
  
  RESULTS
  The LLR and LRFA groups were homogeneous with regard to age, sex, etiology of liver cirrhosis, and AFP levels. The overall survival (OS) and disease-free survival (DFS) probability was 0.354 and 0.260, respectively. A significantly higher OS was observed in the LLR group (LLR: 0.442; LRFA: 0.261;P= 0.048), whereas no statistical difference was found for DFS (LLR: 0.206; LRFA: 0.286;P= 0.205). In the LRFA group was treated a greater number of nodules (LLR: 1.41 ± 0.77; LRFA: 2.72 ± 1.54;P< 0.001). Cox regression analysis found the number of intraoperative HCC nodules as the unique variable statistically significant for OS (hazard ratio: 2.225;P< 0.001). The rank-hazard plot showed a steeper increase of relative hazard for intraoperative nodules > 2.
  
  
  CONCLUSIONS
  Our preliminary results confirm the superiority of hepatic resection on thermoablation in the treatment of small HCC in selected patients, when both approaches are made laparoscopically. LLR showed better results compared to LRFA in terms of OS. These data need to be confirmed by further studies on a larger number of patients.
authors.affiliation: Marco Casaccia, Giuliano Bottino, Pietro Diviacco, Enzo Andorno, Department of Surgery, IRCCS, San Martino University Hospital-IST, University of Genoa, 16132 Genoa, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Casaccia
authors.affiliation: Marco Casaccia, Giuliano Bottino, Pietro Diviacco, Enzo Andorno, Department of Surgery, IRCCS, San Martino University Hospital-IST, University of Genoa, 16132 Genoa, Italy.
authors.forename: Gregorio
authors.initials: G
authors.lastname: Santori
authors.affiliation: Marco Casaccia, Giuliano Bottino, Pietro Diviacco, Enzo Andorno, Department of Surgery, IRCCS, San Martino University Hospital-IST, University of Genoa, 16132 Genoa, Italy.
authors.forename: Giuliano
authors.initials: G
authors.lastname: Bottino
authors.affiliation: Marco Casaccia, Giuliano Bottino, Pietro Diviacco, Enzo Andorno, Department of Surgery, IRCCS, San Martino University Hospital-IST, University of Genoa, 16132 Genoa, Italy.
authors.forename: Pietro
authors.initials: P
authors.lastname: Diviacco
authors.affiliation: Marco Casaccia, Giuliano Bottino, Pietro Diviacco, Enzo Andorno, Department of Surgery, IRCCS, San Martino University Hospital-IST, University of Genoa, 16132 Genoa, Italy.
authors.forename: Enzo
authors.initials: E
authors.lastname: Andorno
mesh_terms: D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000601:surgery*; D017115:Catheter Ablation; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D010535:Laparoscopy; D008113:Liver Neoplasms / Q000401:mortality / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000601:surgery; D011336:Probability; D016016:Proportional Hazards Models; D011846:Radio Waves; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Disease-free survival; Hepatocellular carcinoma; Laparoscopic liver resection; Laparoscopic radiofrequency ablation; Survival