Efficacy and safety of radiofrequency ablation and surgery for hepatocellular carcinoma in patients with cirrhosis: A meta-analysis

Abstract

Background: The aim of this study was to compare the efficacy and safety of surgical resection (RES) and radiofrequency ablation (RFA) in hepatocellular carcinoma (HCC) patients with cirrhosis and to evaluate short- and long-term clinical outcomes. Methods: The EMBASE, Cochrane Central Register of Control Trials and Medline databases were searched for comparative studies of RES and RFA in HCC patients with cirrhosis from inception until 30 April 2021. Overall survival (OS), disease-free survival (DFS), local recurrence rate, complication rate, hospitalization duration and operation time were compared between the 2 groups. Begg’s funnel plot and Egger’s test were performed to assess publication bias. Results: A total of 16 studies met our inclusion criteria, including 1 randomized controlled trial. A total of 3760 patients were included, of which 2007 received RES and 1753 received RFA. The results showed that the 3-year OS rate, 5-year OS rate, 1-year DFS rate and 3-year DFS rate in the RFA group compared with the RES treatment group were significantly lower, and the local recurrence rate in the RFA group was significantly higher than that in the RES group. Compared with the RES group, the RFA group had lower postoperative complication rates, shorter operative times, and no significant difference in hospitalization duration. Subgroup analysis of laparoscopic RFA showed that there was no significant difference in 1- and 5-year OS rates and 3-year and 5-year DFS rates between the 2 groups, while the 3-year OS rates and 1-year DFS rates in the RES group were better than those in the laparoscopic RFA group. Conclusion: Surgery is widely applied among HCC patients with cirrhosis, providing acceptable short- and long-term results.

Treatment options for solitary hepatocellular carcinoma ≤5 cm: surgery vs. ablation: a multicenter retrospective study

“…Zhang et al 11 examined a large number of solitary HCC as we did in the present study and concluded that surgery was superior both in OS and RFS for HCCs measuring >3 cm and ≤5 cm. A possible reason for this inferiority of ablation is shorter OS and RFS in the ablation group than in our study because of the low successful ablation rate.…”

“…Special techniques, such as artificial ascites and pleural effusion, may be required to ensure the success of the ablation and minimize the risk of complications from the ablation affecting nearby organs. Zhang et al 11 examined a large number of solitary HCC as we did in the present study and concluded that surgery was superior both in OS and RFS for HCCs measuring >3 cm and ≤5 cm. A possible reason for this inferiority of ablation is shorter OS and RFS in the ablation group than in our study because of the low successful ablation rate.…”

“…However, several studies have suggested that surgery may be superior to ablation in terms of overall survival (OS) and recurrence-free survival (RFS). [8][9][10][11] A study also indicated that surgery is superior in terms of RFS, even if the OS is the same. 12 Some studies have also found that surgery is superior to ablation for HCCs measuring >2 cm.…”

Magnetic resonance imaging-based rim enhancement could effectually predict poor prognosis in hepatocellular carcinoma: a meta-analysis

“…In China, it has been estimated that there were approximately 395 000 new cases of HCC in 2020, accounting for 24% of newly diagnosed HCC cases worldwide [2]. Currently, surgical resection and radiofrequency ablation (RFA) are viewed as radical treatments for early-stage HCC patients [3][4][5]. Nevertheless, the outcome of HCC patients is still unfavorable, with a 5-year recurrence rate ranging from 60 to 70% [6][7][8].…”