Comparison of percutaneous and surgical approaches for radiofrequency ablation of small and medium hepatocellular carcinoma

Hypothesis: Radiofrequency ablation (RFA) for hepatocellular carcinoma (HCC) can be performed by percutaneous or surgical approach. Tumor size is an important consideration while deciding the treatment approach. Design: Case series with prospective data collection. Setting: A tertiary referral center. Patients: A total of 228 patients who underwent RFA of small (<= 3 cm; n = 155) and medium (3.1-5 cm; n = 73) HCC by percutaneous or surgical approach. Main Outcome Measures: Complete ablation rate, post-RFA complications, treatment-related mortality, and overall and disease-free survival. Results: In patients with small HCC, the complete ablation rate was 95% with both approaches (P > .99). Complication rate (P < .001) and hospital stay (P < .001) were higher with the surgical approach. One-year and 3-year survival rates were 91% and 71%, respectively, in the percutaneous group, and 89% and 57%, respectively, in the surgical group (P= .30). In patients with medium HCC, the complete ablation rate was similar between the surgical and the percutaneous groups (92% vs 95%; P= .48), and the complication rate was also comparable (P= .17). The 1-year and 3-year survival rates were 92% and 68%, respectively, in the surgical group, significantly superior to the corresponding rates of 81% and 42% in the percutaneous group (P= .03). Conclusions: In patients with small HCC, the percutaneous approach achieved similar tumor control with lower morbidity compared with the surgical approach and should be the preferred approach provided that tumor location is suitable. For medium HCC, the surgical approach seems to achieve better overall survival and may be a preferred option.