Pure laparoscopic liver resection versus percutaneous radiofrequency ablation for small hepatocellular carcinoma: a propensity score and multivariate analysis

Cheng, Kai-Chi; Ho, Kit-Man

doi:10.21037/tcr-21-1045

Cited by 7 publications

(7 citation statements)

References 42 publications

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“…Four [ 21 , 24 , 26 , 27 ] of the eight included studies reported local recurrence outcomes for small hepatocellular carcinoma treated with LH vs. PRFA. The overall results showed that the local recurrence of small HCC treated with LH was significantly less than that of patients treated with PRFA (OR: 0.19, 95% CI: 0.12 to 0.32, I 2 = 48%, P = 0.12), as shown in Fig.…”

Section: Resultsmentioning

confidence: 99%

Comparison of laparoscopic hepatectomy and percutaneous radiofrequency ablation for the treatment of small hepatocellular carcinoma: a meta-analysis

Liu,

Tan,

Luo

et al. 2024

BMC Surg

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Aim The purpose of this study was to compare the long-term outcomes of laparoscopic hepatectomy (LH) and percutaneous radiofrequency ablation (PRFA) for the treatment of small hepatocellular carcinoma. Methods We systematically searched PubMed, Embase, Web of Science, and Medline from January 2000 to May 2022 for literature comparing the efficacy of LH and PRFA in the treatment of small hepatocellular carcinoma (largest tumour diameter ≤ 3 cm, number of intrahepatic tumours ≤3, or diameter of a single intrahepatic lesion ≤5 cm. ). We assessed overall survival (OS), recurrence-free survival (RFS), local recurrence and complication rates. Results A total of 1886 patients with small HCC were included in the 8 studies included in this study, of which 839 underwent LH and 1047 underwent PRAF. The results of the meta-analysis showed that the two groups had the same 3-year (HR: 0.99, 95% CI: 0.67 to 1.47) and 5-year (HR: 1.30, 95% CI: 0.90 to 1.87) OS rates, and the LH group had better 3-year (HR: 0.58, 95% CI: 0.49 to 0.68) and 5-year (HR: 0.56, 95% CI: 0.37 to 0.85) RFS rates. The LH group had a lower local recurrence rate (OR: 0.19, 95% CI: 0.12 to 0.32), but the PRFA group had a lower complication rate (OR: 2.49, 95% CI: 1.76 to 3.54). Conclusion There was no difference in OS between LH and PRFA in the treatment of small HCC. LH had a higher RFS rate and a lower local recurrence rate, but PRFA had a lower complication rate. In general, the long-term efficacy of LH in the treatment of small HCC is better than that of PRFA. Considering the advantages of less trauma and a low complication rate of PRFA, a large number of RCT studies are needed for further verification in the future.

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Section: Resultsmentioning

confidence: 99%

Comparison of laparoscopic hepatectomy and percutaneous radiofrequency ablation for the treatment of small hepatocellular carcinoma: a meta-analysis

Liu,

Tan,

Luo

et al. 2024

BMC Surg

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“…Although numerous studies have compared LLR and pRFA for patients with early-stage HCC [9][10][11][17][18][19][20][21][22][23], to our knowledge, only three studies have focused on patients with early-stage HCC and a single tumor ≤ 3.0 cm in size [9][10][11]. Lee et al enrolled 566 patients with a single HCC of ≤ 3 cm treated with either LLR (n = 251) or pRFA (n = 315).…”

Section: Discussionmentioning

confidence: 99%

Overall survival is similar between laparoscopic liver resection versus percutaneous radiofrequency ablation for single hepatocellular carcinoma≦3.0 cm

Yen,

Li,

Hung

et al. 2023

Preprint

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Purpose Inconsistent results have been noted for the difference in survival outcome between laparoscopic liver resection (LLR) and percutaneous radiofrequency ablation (pRFA) for single hepatocellular carcinoma (HCC) ≤ 3.0 cm in size. We aimed to clarify this issue. Methods From 2011 to 2021, 232 patients undergoing LLR and 507 patients undergoing pRFA for early-stage HCC with a single tumor of ≤ 3.0 cm were enrolled. The patients had Child–Pugh class A liver disease. Survival analysis with propensity score matching (PSM) was performed using the Kaplan − Meier method. Results Before PSM, LLR was associated with a significant survival benefit compared to pRFA (five-year overall survival [OS]: p = 0.034; five-year recurrence-free survival [RFS]: p < 0.001). Multivariate analysis showed that the pRFA vs LR comparison was not associated with five-year OS (p = 0.063); however, it was associated with inferior five-year RFS (p < 0.001). After PSM, five‐year OS did not differ significantly between the two groups (p = 0.184); however, LLR resulted in superior RFS compared to pRFA (p < 0.001). Conclusion LLR resulted in superior five-year RFS compared to pRFA in treating early-stage HCC with a single tumor ≤ 3.0 cm in size; however, five-year OS was not significantly different between LLR and pRFA.

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“…Our meta-analysis included 19 observational studies (15,(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41)(42)(43)(44)(45)(46), compromising 3756 patients. Of which, only one study was prospective (44), while all remaining studies were retrospective (15,(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41)(42)(43)45,46). The included studies were conducted in ve different countries: China (n = 7), Japan (n = 4), Korea (n = 3), Italy (n = 3), and Taiwan (n = 2).…”

Section: Characteristics Of Individual Studiesmentioning

confidence: 99%

“…The included studies were conducted in ve different countries: China (n = 7), Japan (n = 4), Korea (n = 3), Italy (n = 3), and Taiwan (n = 2). The follow-up duration ranged from one year in Wu 2020 (44) to about 17 years in Cheng 2022 (43). All included studies used percutaneous RFA, except for Casaccia 2017(15), Santambrogio 2017(33), Tsukamoto 2019 (31), and Ko 2022 (39), which used laparoscopic RFA.…”

Section: Characteristics Of Individual Studiesmentioning

confidence: 99%

“…According to the NOS, the quality of included studies ranged from six to nine points, indicating good to fair quality and low risk of bias in the included studies. Only one study scored nine (32); however, 12 studies scored eight (15,29,31,(33)(34)(35)(36)(37)39,40,42,44,45), four studies scored seven (30,38,41,43), and three studies scored six(36,46). We summarized the included studies and their patients' baseline characteristics in Table 1and Supplementary table 1 respectively.…”

Section: Characteristics Of Individual Studiesmentioning

confidence: 99%

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Efficacy and safety of laparoscopic liver resection versus radiofrequency ablation in patients with early and small hepatocellular carcinoma: an updated meta-analysis and meta- regression of observational studies

Abdelgalil,

Amer,

Yasen

et al. 2023

Preprint

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Background Hepatocellular carcinoma (HCC) is the most common type of liver cancer, accounting for 90% of cases worldwide and a significant contributor to cancer-related deaths. This study comprehensively compares the safety and efficacy of laparoscopic liver resection (LLR) versus laparoscopic or percutaneous radiofrequency ablation (LRFA or PRFA) in patients with early and small HCC. Methods We systematically searched Cochrane Library, PubMed, Scopus, and Web of Science databases to include studies comparing LLR versus LRFA or PRFA in patients with early HCC meets the Milan criteria (defined as solitary nodule < 5 cm or three nodules ≤ 3 cm with no extrahepatic spread or vascular invasion). Pooled results were examined for overall survival, disease-free survival, recurrence-free survival, local, intrahepatic and extrahepatic recurrence rates, and complications. We conducted subgroup analyses based on the type of RFA. Meta-regression analyzed the association between overall survival, local recurrence, and various factors. The quality of the included studies was assessed using the Newcastle-Ottawa Scale. We analyzed the data using the R (v.4.3.0) programming language and the "meta" package of RStudio software. Results We included 19 observational studies, compromising 3756 patients. LLR showed higher 5-year overall survival compared to RFA (RR = 1.17, 95% CI [1.06, 1.3], P > 0.01). Our subgroup analysis showed that LLR had higher 5-year survival than PRFA (RR = 1.15, 95% CI [1.02, 1.31], P = 0.03); however, there was no significant difference between LLR and LRFA (RR = 1.26, 95% CI [0.98, 1.63], P = 0.07). LLR was associated with higher disease-free survival) RR = 1.19, 95% CI [1.05, 1.35], P < 0.01; RR = 1.61, 95% CI [1.31, 1.98], P < 0.01(and recurrence-free survival) RR = 1.21, 95% CI [1.09, 1.35], P < 0.01; RR = 1.45, 95% CI [1.15, 1.84], P < 0.01(at 1 and 3 years. LLR was associated with lower local (RR = 0.28, 95% CI [0.16, 0.47], P < 0.01) and intrahepatic recurrence (RR = 0.7, 95% CI [0.5, 0.97], P = 0.03) than RFA. However, complications were significantly higher with LLR (RR = 2.01, 95% CI [1.51, 2.68], P < 0.01). Our meta-regression analysis showed that younger patients had higher risk for local recurrence (P = 0.008), while age wasn't significantly linked to overall survival (P = 0.25). Other covariates like total bilirubin, alpha-fetoprotein levels, and tumor size also showed no significant associations with either overall survival or local recurrence. Conclusion LLR offers improved long-term outcomes and lower recurrence rates than PRFA. However, no significant distinctions were observed between LRFA and LLR in overall survival, recurrence-free survival, and local recurrence. More robust well-designed RCTs are essential to validate our findings.

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Pure laparoscopic liver resection versus percutaneous radiofrequency ablation for small hepatocellular carcinoma: a propensity score and multivariate analysis

Abstract: Contributions: (I) Conception and design: KC Cheng; (II) Administrative support: KM Ho; (III) Provision of study materials or patients: KC Cheng;

Cited by 7 publications

References 42 publications

Comparison of laparoscopic hepatectomy and percutaneous radiofrequency ablation for the treatment of small hepatocellular carcinoma: a meta-analysis

Comparison of laparoscopic hepatectomy and percutaneous radiofrequency ablation for the treatment of small hepatocellular carcinoma: a meta-analysis

Overall survival is similar between laparoscopic liver resection versus percutaneous radiofrequency ablation for single hepatocellular carcinoma≦3.0 cm

Efficacy and safety of laparoscopic liver resection versus radiofrequency ablation in patients with early and small hepatocellular carcinoma: an updated meta-analysis and meta- regression of observational studies

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