Giulio C Vitali1, Alexis Laurent2, Sylvain Terraz3,4, Pietro Majno5,4, Nicolas C Buchs5, Laura Rubbia-Brandt4,6, Alain Luciani7, Julien Calderaro8, Philippe Morel5,4, Daniel Azoulay2, Christian Toso9,10. 1. Divisions of Transplant and Abdominal Surgery, Department of Surgery, University of Geneva Hospitals, Rue Gabrielle-Perret-Gentil, 1211, Geneva, Switzerland. giuliocesare.vitali@gmail.com. 2. Department of Hepato-Biliary Surgery and Liver Transplantation, Hôpital Henri Mondor, Créteil, France. 3. Department of Radiology, University of Geneva Hospitals, Geneva, Switzerland. 4. Hepato-Pancreato-Biliary Centre, University of Geneva Hospitals, Geneva, Switzerland. 5. Divisions of Transplant and Abdominal Surgery, Department of Surgery, University of Geneva Hospitals, Rue Gabrielle-Perret-Gentil, 1211, Geneva, Switzerland. 6. Division of Clinical Pathology, University of Geneva Hospitals, Geneva, Switzerland. 7. Department of Radiology, Hôpital Henri Mondor, Créteil, France. 8. Department of Pathology, Hôpital Henri Mondor, Créteil, France. 9. Divisions of Transplant and Abdominal Surgery, Department of Surgery, University of Geneva Hospitals, Rue Gabrielle-Perret-Gentil, 1211, Geneva, Switzerland. christian.toso@hcuge.ch. 10. Hepato-Pancreato-Biliary Centre, University of Geneva Hospitals, Geneva, Switzerland. christian.toso@hcuge.ch.
Abstract
BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSION: 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.
BACKGROUND: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. METHODS: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. RESULTS: 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. CONCLUSION: 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.
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