Abstract
Background: Radiofrequency ablation (RFA) is a curative modality for hepatocellular carcinoma (HCC) patients who are not suitable for resection. It remains controversial whether a surgical or percutaneous approach is more appropriate for HCC.Method: A search was performed on the PubMed, Web of Science, Embase, and Cochrane Library databases from the date of database inception until April 17, 2021. Studies reporting outcomes of comparisons between surgical RFA (SRFA) and percutaneous RFA (PRFA) were included in this study. The meta-analysis was performed using the Review Manager 5.3 and Stata 12.0 software.Result: A total of 10 retrospective studies containing 12 cohorts, involving 740 patients in the PRFA group and 512 patients in the SRFA group, were selected. Although the tumor size in PRFA group was smaller than the SRFA group (p = 0.007), there was no significant difference in complete ablation rate between the SRFA and PRFA groups (95.63% and 97.33%, respectively; Odds ratio [OR], 0.56; 95% confidence intervals [CI], 0.26–1.24; p = 0.15). However, the SRFA group showed a significantly lower local tumor recurrence than the PRFA group in the sensitivity analysis (28.7% in the PRFA group and 21.79% in the SRFA group, respectively; OR, 1.84; 95% CI, 1.14–2.95; p = 0.01). Pooled analysis data showed that the rate of severe perioperative complications did not differ significantly between the PRFA and SRFA groups (14.28% and 12.11%, respectively; OR, 1.30; 95% CI, 0.67-2.53; p = 0.44). There was no significant difference in the 1-, 3-, and 5-year overall survival rates, as well as the 1- and 3-year disease-free survival (DFS) between the PRFA and SRFA groups. The 5-year DFS of the PRFA group was significantly lower than the SRFA group (hazard ratio 0.73; 95% CI 0.54–0.99).Conclusion: Based on our meta-analysis, the surgical route was superior to PRFA in terms of local control rate. Furthermore, the surgical approach did not increase the risk of major complications.
Highlights
Radiofrequency ablation (RFA) is recognized as a curative modality for early-stage hepatocellular carcinoma (HCC), especially in patients who are not suitable for resection and liver transplantation [1,2,3,4]
The percutaneous radiofrequency ablation (PRFA) group appeared to have a lower complete ablation rate than the surgical radiofrequency ablation (SRFA) group, a meta-analysis using the fixed effects model revealed no significant difference in complete ablation rate between the two groups (95.63 and 97.33%, respectively; odds ratio (OR), 0.56; 95%confidence intervals (CI), 0.26–1.24; p = 0.15), as well as no statistical heterogeneity (χ 2 = 3.45; p = 0.49, I2 = 0%; Figure 2)
The indifferent rate of complete ablation resulted in no significant difference in the rates of local recurrence between the PRFA and SRFA groups (18.54 and 21.05%, respectively; OR, 1.05; 95% CI, 0.41–2.66; p = 0.92; Figure 3D), and statistical heterogeneity was moderate (χ2 = 13.40; p = 0.009, I2 = 70%)
Summary
Radiofrequency ablation (RFA) is recognized as a curative modality for early-stage hepatocellular carcinoma (HCC), especially in patients who are not suitable for resection and liver transplantation [1,2,3,4]. Percutaneous radiofrequency ablation (PRFA) is associated with lower accuracy in cancer staging, poor accessibility in certain areas of the liver, can damage or perforate adjacent visceral organs, and cause diaphragmatic injury [6,7,8]. These issues can be addressed using surgical radiofrequency ablation (SRFA), which is performed with open and laparoscopic approaches utilizing an intraoperative ultrasonic (IOUS) probe. Radiofrequency ablation (RFA) is a curative modality for hepatocellular carcinoma (HCC) patients who are not suitable for resection It remains controversial whether a surgical or percutaneous approach is more appropriate for HCC
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