Radiofrequency ablation versus repeat hepatectomy in the treatment of recurrent hepatocellular carcinoma in subcapsular location: a retrospective cohort study

Abstract

Background Repeat hepatectomy and radiofrequency ablation (RFA) are widely used to treat early recurrent hepatocellular carcinoma (RHCC) located in the subcapsular region, but the optimal treatment strategy remains to be controversial. Methods A total of 126 RHCC patients in the subcapsular location after initial radical hepatectomy were included in this study between Dec 2014 and Jan 2018. These patients were divided into the RFA group (46 cases) and the repeat hepatectomy group (80 cases). The primary endpoints include repeat recurrence-free survival (rRFS) and overall survival (OS), and the secondary endpoint was complications. The propensity-score matching (PSM) was conducted to minimize the bias. Complications were evaluated using the Clavien-Dindo classification, and severe complications were defined as classification of complications of ≥grade 3. Results There were no significant differences in the incidence of severe complications were observed between RFA group and repeat hepatectomy group in rRFS and OS both before (1-, 2-, and 3-year rRFS rates were 65.2%, 47.5%, and 33.3% vs 72.5%, 51.2%, and 39.2%, respectively, P = 0.48; 1-, 2-, and 3-year OS rates were 93.5%, 80.2%, and 67.9% vs 93.7%, 75.8%, and 64.2%, respectively, P = 0.92) and after PSM (1-, 2-, and 3-year rRFS rates were 68.6%, 51.0%, and 34.0% vs 71.4%, 42.9%, and 32.3%, respectively, P = 0.78; 1-, 2-, and 3-year OS rates were 94.3%, 82.9%, and 71.4% vs 88.6%, 73.8%, and 59.0%, respectively, P = 0.36). Moreover, no significant differences in the incidence of severe complications were observed between the RFA group and repeat hepatectomy group. Conclusion Both repeat hepatectomy and RFA are shown to be effective and safe for the treatment of RHCC located in the subcapsular region.

Comparison of the efficacy and safety of repeated hepatectomy and radiofrequency ablation in the treatment of primary recurrent liver cancer: a meta-analysis

“…If the heterogeneity test is P ≥ 0.1 and I 2 ≤ 50%, it indicates that there is homogeneity between studies, and the fixed effects model is used for combined analysis; if P < 0.1, I 2 > 50%, it indicates that the study, if there is heterogeneity, use sensitivity analysis to find the source of heterogeneity. If the heterogeneity is still large, use the random effects model or give up the combination of results and use descriptive analysis [ 10 ]. Funnel plot and Egger’s test were used to analyze publication bias [ 10 ].…”

“…If the heterogeneity is still large, use the random effects model or give up the combination of results and use descriptive analysis [ 10 ]. Funnel plot and Egger’s test were used to analyze publication bias [ 10 ].…”

“…The results of a meta-analysis by Jin et al showed that laparoscopic hepatectomy is preferred over RFA treatment with a better radical effect, but RFA treatment is more beneficial with smaller trauma, development of less complications, and shorter operating time [ 9 ]. Wei et al [ 10 ] found that both repeat hepatectomy and RFA are shown to be effective and safe for the treatment of recurrent hepatocellular carcinoma located in the subcapsular region. However, the clinical treatment of recurrent liver cancer has not yet reached a consensus, and there is still controversy about the comparison of the efficacy and safety of RH and RFA in the treatment of recurrent liver cancer.…”

Recurrent Hepatocellular Carcinoma: Patterns, Detection, Staging and Treatment

“…In particular, several studies have noted no difference in outcomes following repeat resection versus ablation among patients with recurrent HCC who met Milan criteria or had early-stage disease according to the Barcelona Clinic Liver Cancer (BCLC) classification. 19 , 56 , 58 , 59 In particular, patients with recurrent tumors less than 3 cm had no difference in post-treatment outcomes following resection versus ablation, yet ablation was associated with a lower incidence of complications. 60 In contrast, patients with recurrences outside the Milan criteria did better in terms of post-recurrence survival after repeat hepatic resection.…”

“…Other studies have failed, however, to confirm a long-term survival benefit of repeat resection over ablation. 20 , 56 , 57 The comparability of repeat resection and ablation relative to long-term outcomes following treatment of recurrent HCC was particularly pronounced among patients with early recurrence. In particular, several studies have noted no difference in outcomes following repeat resection versus ablation among patients with recurrent HCC who met Milan criteria or had early-stage disease according to the Barcelona Clinic Liver Cancer (BCLC) classification.…”