S Di Sandro1, L Benuzzi2, A Lauterio2, F Botta3, R De Carlis4, M Najjar5, L Centonze6, M Danieli2, I Pezzoli2, A Rampoldi6, V Bagnardi3, L De Carlis7. 1. Department of General Surgery and Transplantation, Niguarda Ca' Granda Hospital, Milan, Italy; Niguarda Transplant Foundation, Niguarda Ca' Granda Hospital, Milan, Italy. Electronic address: stefano.disandro@ospedaleniguarda.it. 2. Department of General Surgery and Transplantation, Niguarda Ca' Granda Hospital, Milan, Italy; Niguarda Transplant Foundation, Niguarda Ca' Granda Hospital, Milan, Italy. 3. Department of Statistics and Quantitative Methods, University of Milan-Bicocca, Milan, Italy. 4. Department of General Surgery and Transplantation, Niguarda Ca' Granda Hospital, Milan, Italy; Department of Surgical Sciences, University of Pavia, Italy. 5. Center for Liver Disease and Transplantation, Columbia University Medical Center, New York Presbyterian Hospital, New York, NY, USA. 6. Department of General Surgery and Transplantation, Niguarda Ca' Granda Hospital, Milan, Italy. 7. Department of General Surgery and Transplantation, Niguarda Ca' Granda Hospital, Milan, Italy; Niguarda Transplant Foundation, Niguarda Ca' Granda Hospital, Milan, Italy; School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.
Abstract
INTRODUCTION: Patients with a single small Hepatocellular Carcinoma (HCC) may be definitively treated by Radiofrequency ablation (RFA) with a very low rate of peri-operative morbidity. However, results are still controversial comparing RFA to Liver Resection (LR). METHODS: All consecutive patients treated by RFA or LR for a single untreated small HCC on liver cirrhosis between January 2006-December 2016 were enrolled. Patients were matched 1:1 basing on: age, MELD-score, platelet count, nodule's diameter, HCV status, α-fetoprotein level, and Albumin-Bilirubin score. First analysis compered LR to RFA. Second analysis compared Laparoscopic LR (LLR) to RFA. RESULTS: Of 484 patients with single small HCC, 91 patients were selected for each group after a 1:1 propensity score matching (PS-M). The 5-years OS was 70% and 60% respectively for LR and RFA group (P = 0.666). The 5-year RFS was 36% and 21% respectively for LR and RFA group (P < 0.001). Patients treated by LR had a significantly longer hospital stay and higher complications rate. Comparing 50 cases of LLR and 50 of RFA, the 5-years OS was 79% and 56% respectively for LLR and RFA group (P = 0.22). The 5-year RFS was 54% and 19% respectively for LR and RFA group (P < 0.001). Post-operative complications were not significantly different. CONCLUSIONS: LLR confers similar peri-operative complications rate compared to RFA. LLR should be considered as a first-line approach for the treatment of a single small HCC as it combines the effectiveness of open LR and the safety profile of RFA.
INTRODUCTION:Patients with a single small Hepatocellular Carcinoma (HCC) may be definitively treated by Radiofrequency ablation (RFA) with a very low rate of peri-operative morbidity. However, results are still controversial comparing RFA to Liver Resection (LR). METHODS: All consecutive patients treated by RFA or LR for a single untreated small HCC on liver cirrhosis between January 2006-December 2016 were enrolled. Patients were matched 1:1 basing on: age, MELD-score, platelet count, nodule's diameter, HCV status, α-fetoprotein level, and Albumin-Bilirubin score. First analysis compered LR to RFA. Second analysis compared Laparoscopic LR (LLR) to RFA. RESULTS: Of 484 patients with single small HCC, 91 patients were selected for each group after a 1:1 propensity score matching (PS-M). The 5-years OS was 70% and 60% respectively for LR and RFA group (P = 0.666). The 5-year RFS was 36% and 21% respectively for LR and RFA group (P < 0.001). Patients treated by LR had a significantly longer hospital stay and higher complications rate. Comparing 50 cases of LLR and 50 of RFA, the 5-years OS was 79% and 56% respectively for LLR and RFA group (P = 0.22). The 5-year RFS was 54% and 19% respectively for LR and RFA group (P < 0.001). Post-operative complications were not significantly different. CONCLUSIONS: LLR confers similar peri-operative complications rate compared to RFA. LLR should be considered as a first-line approach for the treatment of a single small HCC as it combines the effectiveness of open LR and the safety profile of RFA.