Surgical resection versus open-approach radiofrequency ablation for small hepatocellular carcinomas within Milan criteria after successful transcatheter arterial chemoembolization.

AIMS: The aim of this study was to compare the effectiveness and safety of hepatic resection versus open-approach RFA (ORFA) for small hepatocellular carcinomas (HCC) within Milan criteria after successful downstaging therapy by transcatheter arterial chemoembolization.
MATERIAL AND METHODS: Between February 2005 and February 2008, a total of 110 patients with advanced HCC met the Milan criteria after successful downstaging therapy; 58 patients then underwent hepatic resection and 52 received ORFA. Outcomes, including short- and long-term morbidity, 1-, 3-, and 5-year mortality and HCC-free survival, were analyzed and compared between the two groups.
RESULTS: Patients in the hepatic resection and ORFA groups showed similar baseline characteristics and downstaging protocols. The ORFA group showed less blood loss, lower hospital costs, shorter surgical time, and fewer hospital stay days (P < 0.05). The 1-, 3-, and 5-year overall survival rates were 94.8, 86.2, and 79.3%, respectively, with liver resection and 96.2, 82.7, and 76.9% with ORFA (P=0.772). The 1-, 3-, and 5-year recurrence-free survival rates were 93.1, 81.0, and 77.6% with resection and 94.2, 76.9, and 73.1% with ORFA (P=0.705). The ORFA patients suffered fewer postoperative complications (P=0.09), particularly among the cases of central HCC (P=0.015).
CONCLUSION: Resection and ORFA achieved similar survival benefits in the management of HCC within Milan criteria after successful downstaging. The decreased blood loss, hospital costs, surgical time, and hospital stay days, and lower complication rates in central cases render ORFA a preferred treatment option.