Minimally invasive surgery versus percutaneous radiofrequency ablation for early-stage hepatocellular carcinoma: Results from a high-volume liver surgery center in East Asia

Yueh-Wei Liu; Yi-Hao Yen; Wei-Feng Li; Chih-Chi Wang; Sheng-Nan Lu; Kwong-Ming Kee; Chee-Chien Yong; Yu-Fan Cheng; Jing-Houng Wang; Tsung-Hui Hu; Chao-Hung Hung; Chien-Hung Chen

doi:10.1016/j.suronc.2022.101769

Minimally invasive surgery versus percutaneous radiofrequency ablation for early-stage hepatocellular carcinoma: Results from a high-volume liver surgery center in East Asia

Surg Oncol. 2022 Jun:42:101769. doi: 10.1016/j.suronc.2022.101769. Epub 2022 Apr 19.

Authors

Affiliations

¹ Liver Transplantation Center and Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.
² Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan. Electronic address: cassellyen@yahoo.com.tw.
³ Liver Transplantation Center and Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan. Electronic address: ufel4996@ms26.hinet.net.
⁴ Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
⁵ Liver Transplantation Center, Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan.

PMID: 35468499
DOI: 10.1016/j.suronc.2022.101769

Abstract

Background & aims: The outcomes of minimally invasive surgery (MIS) vs. percutaneous radiofrequency ablation (RFA) in treating early-stage hepatocellular carcinoma (HCC) remain inconclusive. This study thus aimed to compare the outcomes of both treatments for early-stage HCCs.

Methods: This retrospective study consecutively enrolled patients with newly diagnosed early-stage HCCs treated with MIS or percutaneous RFA between 2011 and 2018. Outcomes were compared between the MIS and RFA groups both before and after 1:1 propensity score matching (PSM).

Results: A total of 119 and 481 patients underwent MIS and percutaneous RFA, respectively. Patients undergoing percutaneous RFA exhibited older age (p = 0.007) and higher rates of Child-Pugh class B (p < 0.001) and multifocal disease (p < 0.001). The median overall survival (OS) was 73.7 months in the MIS group, which was significantly higher than that for the RFA group of 65.1 months (p = 0.003). 50% HCC recurrence after MIS was not reached. The mean recurrence-free survival (RFS) was 49.6 months for the MIS group, which was significantly higher than the RFA group of 41.3 months (p < 0.001). On multivariate analysis, age ≥65 (HR: 1.61; 95% CI: 1.13-2.31, p = 0.009), RFA (HR: 2.21; 95% CI: 1.14-4.29, p = 0.019), and Child-Pugh class B (HR: 2.03; 95% CI: 1.29-3.21, p = 0.002) remained risk factors for OS, and RFA (HR: 2.18; 95% CI: 1.42-3.35; p < 0.001) remained a risk factor for RFS. After PSM, 103 patients were included in each group. No significant difference in OS was identified (p = 0.198), but RFS was higher in the MIS group than the RFA group (p = 0.003). Severe postoperative complications occurred at the same rate (1%) in both groups (p > 0.99).

Conclusion: After PSM, severe postoperative complication and OS rates were found to be comparable between the MIS and RFA groups, but RFS was higher in the MIS group than the RFA group, suggesting that MIS may have better outcomes for patients with early-stage HCC.

Keywords: Hepatocellular carcinoma; Minimally invasive surgery; Radiofrequency ablation.

MeSH terms

Carcinoma, Hepatocellular* / pathology
Catheter Ablation* / methods
Hepatectomy / methods
Humans
Liver Neoplasms* / pathology
Minimally Invasive Surgical Procedures
Neoplasm Recurrence, Local / surgery
Postoperative Complications
Radiofrequency Ablation*
Retrospective Studies
Treatment Outcome