Surgical resection versus ablation for hepatocellular carcinoma ≤ 3 cm: a population-based analysis

Abstract

Resection of HCC ≤ 3 cm results in better long-term survival as compared with ablation. Treatment strategies for small solitary HCC should emphasize a resection first approach, with ablation being reserved for patients precluded from surgery.

External radiation or ablation for solitary hepatocellular carcinoma: A survival analysis of the SEER database

“…This study demonstrates an increasing risk of death as tumor size increases. These results support previous work correlating size of HCC lesions to outcomes following ablation . The hazard ratios with increasing size reported by the current study demonstrate that 3 cm is an important metric to guide therapeutic decisions.…”

“…There are various AT techniques, with previous reports citing microwave ablation (MWA) and RFA as the most commonly used, and requiring fewer applications than percutaneous ethanol injection (PEI) . The vast majority of patients in this study were coded as “heat‐radio‐frequency ablation,” encompassing MWA and RFA, and supporting the applicability of the current study's results to these two modalities . Finally, confounding and selection biases are inherent to any data registry, though PS matching accounts for these biases and allows for a more focused treatment‐specific analysis.…”

“…This advantage of resection over ablation was demonstrated in multiple subgroups, including size of lesion, multifocal lesions, and cirrhotic patients . Even for early stage disease, a recent retrospective analysis examining patients with single HCC lesions <3 cm demonstrated an advantage for resection over ablation …”

“…A 2010 randomized controlled trial of HCC patients with lesions conforming to the Milan criteria compared resection to ablation, and demonstrated superior OS and recurrence‐free survival for surgical resection. Recent reports support that for small HCC lesions, resection provides better long‐term outcomes compared to ablation, with a recent meta‐analysis demonstrating resection as particularly effective for tumors larger than 3 cm …”

Ablation approach for primary liver tumors: Peri‐operative outcomes

“…Hepatectomy and transplantation are the definitive treatments for primary liver tumors such as hepatocellular carcinoma and intrahepatic cholangiocarcinoma . However, due to patient comorbidities, tumor location, and extent of required resection, ablation is an important therapeutic option for these lesions .…”