Abstract
Aim: Is to compare the short-term outcome of hepatic resection and radiofrequency ablation (RFA) in two groups of patients with a solitary hepatocellular carcinoma (HCC) less than 5 em in Childs A cirrhotic patients. Patients and methods: The study comprised 60 patients; 52 (86.7%) males and 8 (13.3%) females, with mean age 45.2±9.6, range 26-67 years. The patients were randomized into 2 groups: Resection group (n=28 patients) assigned to undergo hepatic resection and radiofrequency group (n= 32 patients) assigned to undergo RFA. The morbidity; hospital stay; overall survival; disease-free survival; psychological and physical welfare of the patients were assessed during the follow up period. Results: There was non-significant difference (P >0.05) in both groups as regards the morbidity (21.4% in resection group versus 15.6% in RFA group).The mean hospital stay was 7±2.9 in resection group and 1±1.2 in RFA group; with a significant shorter stay (P<0.001) in RFA group. Patients included in RFA group showed significantly increased scores of psychological and physical welfare compared to resection group (P<0.001). Subgroup analysis showed non significant difference between both groups as regards the 2 years overall survival & recurrence-free survival in tumours less than 3cm.On the other hand, surgical resection was superior to RFA for 2 years overall survival & the recurrence-free survival in subgroup analyses for lesions > 3cm, <5cm. Conclusion: In patients with ChildA cirrhosis with solitaryHCC >3cm, RFAprovided results with non-significant difference to surgical resection with the advantages of being less invasive, shorter hospital stay, and better quality of life. While in tumours between 3 and 5 em, surgical resection was superior to RFA having better overall survival and tumour-free recurrence
Highlights
Hepatocellular carcinoma (HCC) is the fifth most common cancer in the world, with an estimated 500,000 deaths per year.1 Advances in diagnostic imaging and widespread application of screening programs in highrisk populations have allowed detection of small HCC, which can be curable by partial hepatic resection (HR), liver transplantation, or local ablation therapies
In the early post-operative period; transient liver failure was reported in 4 patients, 2 (7.1%) in resection group and 2 (6.2%) in radiofrequency ablation (RFA) group, they were responded to conservative treatment; mild pleural effusion in 3 patients, 1 (3.6%) in resection group and 2 (6.2%) in RFA group; bile leak in 1 (3.6%) patient in resection group; hepatic abscess in 1(3.1%) case in RFA group; and wound infection in 2 (7.1%) patients in resection group
Liver transplantation has the best results in terms of overall survival and disease-free survival, but only few patients can be submitted to this treatment because of organ shortage
Summary
Hepatocellular carcinoma (HCC) is the fifth most common cancer in the world, with an estimated 500,000 deaths per year. Advances in diagnostic imaging and widespread application of screening programs in highrisk populations have allowed detection of small HCC, which can be curable by partial hepatic resection (HR), liver transplantation, or local ablation therapies. Advances in diagnostic imaging and widespread application of screening programs in highrisk populations have allowed detection of small HCC, which can be curable by partial hepatic resection (HR), liver transplantation, or local ablation therapies. Liver transplantation, which offers the potential to both resect the entire potentially tumourbearing liver and to eliminate the cirrhosis, achieves the best results but can be offered only to a minority of patients because of the shortage of donors and high cost.. Ain-Shams J Surg 2013; 6(1): hemorrhage and limits the extent of surgery increases the risk of postoperative liver failure. Many nonsurgical ablative methods have been developed for patients with small HCC not eligible for surgery, such as cryoablation, percutaneous ethanol injection, acetic acid injection, radiofrequency ablation (RFA), microwave coagulation and transcatheter arterial chemoembolization.
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