Radiofrequency Ablation for Recurrent Hepatocellular Carcinoma: Comparison to Repeated Resection and Discussion of Salvage Liver Transplantation

Abstract

Background: Recurrence of hepatocellular carcinoma (HCC) after surgical treatment is a common problem. It can be treated by radiofrequency ablation (RFA) or repeated hepatic resection (HR). We report on a comparison of both in a retrospective, single-institution database in order to provide a basis for a discussion of the indication for salvage liver transplantation. Patients and methods: A prospectively collected database was retrospectively analyzed. Among a total of 425 hepatic resections (HR) and 92 radiofrequency ablations (RFA) for HCC, 27 HR and 27 RFA procedures were performed due to HCC recurrence following previous surgical treatment. The initial treatment was HR (15 in the RFA and 25 in the HR patients) or RFA (12 in the RFA and 2 in the HR patients). RFA was performed under ultrasound control using two different monopolar devices. All kinds of access were used: open surgical (n= 10), percutaneous (n= 13) and laparoscopic (n= 4). HR was performed using an ultrasound aspiration device. Indication for a particular treatment was allocated on a case-by-case basis; the final decision was often made intraoperatively. Results: Survival was 100%, 78%, 68%, 52% and 39% (HR) vs. 96%, 72%, 62%, 40% and 32% (RFA) at 1, 2, 3, 4 and 5 years, respectively, and tumor-free survival was 82%, 50%, 45%, 39% and 28% (HR) vs. 51%, 30%, 30%, 22% and 11% (RFA) at 1, 2, 3, 4 and 5 years, respectively (see figure). Survival after RFA (median 40 months) was similar compared to that after HR (48 months, p=0.641, logRank-test). Tumor-free survival was markedly impaired after RFA (15 vs. 29 months). This difference was however not significant (p=0.07, logRank-test). Both groups were different regarding occurrence of cirrhosis, maximal tumor size, time after initial diagnosis and duration of the procedure.[Figure]Conclusion: In this non-randomized retrospective trial, survival and disease-free survival was not significantly different when compared between patients treated by RFA and HR. There was however a tendency towards a longer tumor-free survival in the resected patients. In the light of these results, the indication for salvage liver transplantation in case of recurrent HCC should be discussed open-minded.