Journal
SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES
Volume 33, Issue 8, Pages 2419-2429Publisher
SPRINGER
DOI: 10.1007/s00464-019-06784-0
Keywords
Small hepatocellular carcinoma; Radiofrequency ablation; Minimally invasive liver surgery; Laparoscopic hepatectomy; Robotic-assisted hepatectomy
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Funding
- Natural Science Foundation for Young Scientists of Gansu Province
- Science & Technology Planning Project of Gansu Province [18JR3RA058]
- Key Laboratory of Evidence Based Medicine and Knowledge Translation Foundation of Gansu Province [GSXZYZH2018006]
- Foundation of Lanzhou Science and Technology Bureau [2017-ZD-38]
- Research Projects of Gansu Provincial Hospital [18GSSY3-1, 18GSSY3-8]
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BackgroundThe aim of this study was to compare radiofrequency ablation (RFA) with minimally invasive liver surgery (MIS) in the treatment of small hepatocellular carcinoma (SHCC) and to assess short-term and long-term clinical outcomes.MethodsPubMed, Embase, Cochrane Library, Web of science, and CBM were systematically searched for articles from inception to July 2018, comparing RFA and MIS in SHCC treatment. We evaluated overall survival (OS), disease-free survival (DFS), local recurrence, and complication rates, as well as hospitalization duration and operation times.ResultsSix retrospective studies were analyzed, including a total of 597 patients, 313 treated with RFA and 284 treated with MIS. OS rates were significantly higher in patients treated with MIS at 3years, when compared to RFA (OR 0.55; 95% CI 0.36 to 0.84). The 3-year DFS MIS rates were also superior to RFA (OR 0.63; 95% CI 0.41 to 0.98). In contrast, when compared to MIS, RFA demonstrated a significantly higher rate of local intrahepatic recurrences, (OR 2.24; 95% CI 1.47 to 3.42), and a lower incidence of postoperative complications (OR 0.34; 95% CI 0.22 to 0.53), as well as shorter operation times (OR -145.31, 95% CI -200.24 to -90.38) and hospitalization duration (OR -4.02,95% CI -4.94 to -3.10).ConclusionsWe found that MIS led to higher OS, DFS, and lower local recurrences in SHCC patients. Meanwhile, RFA treatments led to significantly lower complication rates, shorter operation times, and hospitalization duration. Considering long-term outcomes, MIS was found to be superior to RFA. However, RFA may be an alternative treatment for patients presenting a single SHCC nodule (<= 3cm), given its minimally invasive nature and its comparable long-term efficacy with MIS. Nevertheless, our findings should be explained with caution due to the low level of evidence obtained.
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