BACKGROUND: Recently randomized controlled trials have been advocated to compare radiofrequency ablation (RFA) and hepatic resection (HR) in resectable tumours and determine whether differences in observed survivals result from the heterogeneity in previous studies between RFA (treating unresectable lesions) and HR (treating lesions deemed resectable). We reviewed the literature that directly compares the treatments and employed an evidence-based approach to examine the data. MATERIALS AND METHODS: All studies comparing RFA and HR were included. Primary outcomes were the overall survival (OS) and disease-free survival (DFS) at 3 and 5 years. A subgroup analysis was conducted for solitary or small tumors (<4 cm for colorectal metastases (CRM) or <5 cm for hepatocellular carcinoma (HCC)). RESULTS: Most studies were retrospective. For CRM, HR was markedly superior to RFA in respect of 3- and 5-year OS as well as 5-year DFS including tumours smaller than 4 cm and solitary lesions. For HCC, HR was markedly superior to RFA for 3- and 5-year OS as well as 3-year DFS, and produced a better OS at 3 years for solitary lesions and DFS at 3 years for small tumours. CONCLUSIONS: Multiple factors determine outcomes following treatment of liver tumours. Small or solitary lesions seem the most appropriate ones to study as this reduces the number of confounding variables, but even in these cases HR confers a better OS and DFS than RFA for both CRM and HCC. If our data are confirmed it will be important to examine other factors influencing the response.
BACKGROUND: Recently randomized controlled trials have been advocated to compare radiofrequency ablation (RFA) and hepatic resection (HR) in resectable tumours and determine whether differences in observed survivals result from the heterogeneity in previous studies between RFA (treating unresectable lesions) and HR (treating lesions deemed resectable). We reviewed the literature that directly compares the treatments and employed an evidence-based approach to examine the data. MATERIALS AND METHODS: All studies comparing RFA and HR were included. Primary outcomes were the overall survival (OS) and disease-free survival (DFS) at 3 and 5 years. A subgroup analysis was conducted for solitary or small tumors (<4 cm for colorectal metastases (CRM) or <5 cm for hepatocellular carcinoma (HCC)). RESULTS: Most studies were retrospective. For CRM, HR was markedly superior to RFA in respect of 3- and 5-year OS as well as 5-year DFS including tumours smaller than 4 cm and solitary lesions. For HCC, HR was markedly superior to RFA for 3- and 5-year OS as well as 3-year DFS, and produced a better OS at 3 years for solitary lesions and DFS at 3 years for small tumours. CONCLUSIONS: Multiple factors determine outcomes following treatment of liver tumours. Small or solitary lesions seem the most appropriate ones to study as this reduces the number of confounding variables, but even in these cases HR confers a better OS and DFS than RFA for both CRM and HCC. If our data are confirmed it will be important to examine other factors influencing the response.
Authors: Stefaan Mulier; Yicheng Ni; Lars Frich; Fernando Burdio; Alban L Denys; Jean-François De Wispelaere; Benoît Dupas; Nagy Habib; Michael Hoey; Maarten C Jansen; Marc Lacrosse; Raymond Leveillee; Yi Miao; Peter Mulier; Didier Mutter; Kelvin K Ng; Roberto Santambrogio; Dirk Stippel; Katsuyoshi Tamaki; Thomas M van Gulik; Guy Marchal; Luc Michel Journal: Ann Surg Oncol Date: 2007-01-24 Impact factor: 5.344
Authors: Hyuk Hur; Yong Taek Ko; Byung Soh Min; Kyung Sik Kim; Jin Sub Choi; Seung Kook Sohn; Chang Hwan Cho; Heung Kyu Ko; Jong Tai Lee; Nam Kyu Kim Journal: Am J Surg Date: 2008-09-11 Impact factor: 2.565
Authors: Gianpiero Gravante; Giuseppe Sconocchia; Seok Ling Ong; Ashley R Dennison; David M Lloyd Journal: Liver Int Date: 2008-10-30 Impact factor: 5.828
Authors: Byoung Chul Lee; Hyun Gu Lee; In Ja Park; So Yeon Kim; Ki-Hun Kim; Jae Hoon Lee; Chan Wook Kim; Jong Lyul Lee; Yong Sik Yoon; Seok-Byung Lim; Chang Sik Yu; Jin Cheon Kim Journal: Medicine (Baltimore) Date: 2016-09 Impact factor: 1.889