Pure Laparoscopic Liver Resection versus Percutaneous Radiofrequency Ablation for Small Hepatocellular Carcinoma: A Propensity Score and Multivariate Analysis

Abstract

Introduction: In treatment of hepatocellular carcinoma (HCC), both laparoscopic liver resection (LLR) and radiofrequency ablation (RFA) provided similar short-term advantages. However, there was no robust clinical trial comparing the efficacy of LLR and RFA especially for small HCC. This study aimed to compare the short-term and long-term outcomes of LLR and RFA for patients with small HCC. Methods: All patients underwent RFA or LLR for small HCC from April 2005 to August 2020 were included. Propensity score matching was conducted to match patients in the LLR group and RFA group. The demographic data, tumor characteristics, operative data, post-operative outcomes and survival data of the two groups were compared. A multivariate analysis based on Cox regression was used to identify factors associated with survival. Results: LLR and RFA had similar overall survival (91.8% vs. 79.2% at 5-year, p=0.060); while the LLR had a significantly better disease-free survival (49.0% vs. 30.3% at 5-year, p=0.002) and local recurrence-free survival (96.0% vs. 63.7% at 5-year, p<0.001) when compared with the RFA. Multivariate analysis showed that treatment received by patient, prothrombin time and platelet counts were significantly associated with disease-free survival. On the other hand, the only factor associated with local recurrence-free survival was the treatment received by patient. Conclusion: Both RFA and LLR are safe and feasible treatment options for patients with small HCC. LLR should be considered for patients with preserved liver function with a better disease-free survival; while RFA offered a comparable overall survival with less surgical trauma and shorter hospital stay.