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Comparison of Percutaneous and Surgical Approaches for Radiofrequency Ablation of Small and Medium Hepatocellular Carcinoma
Muhammad Rizwan Khan, MBBS;
Ronnie T. P. Poon, MS;
Kelvin K. Ng, PhD;
Albert C. Chan, MBBS;
Jimmy Yuen, MBBS;
Helen Tung, MBBS;
Jason Tsang, MBBS;
Sheung Tat Fan, MS, MD, PhD, DSc
Arch Surg. 2007;142(12):1136-1143.
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.
Author Affiliations: Departments of Surgery (Drs Khan, Ng, Chan, and Fan and Mr Poon) and Radiology (Drs Yuen, Tung, and Tsang), Centre for the Study of Liver Disease, The University of Hong Kong, Pokfulam, Hong Kong, China.
RELATED ARTICLE
Comparison of Percutaneous and Surgical Approaches for Radiofrequency Ablation of Small and Medium Hepatocellular Carcinoma—Invited Critique
Michael E. deVera, James W. Marsh, and T. Clark Gamblin
Arch Surg. 2007;142(12):1143.
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