Treatment of Hepatocarcinoma in Early Stages: Hepatic Resection versus Radiofrequency, a Systemic Review

Abstract

Purpose: To assess the efficacy and safety of radiofrequency ablation (RFA) versus liver resection (LR) for initial stages of hepatocellular carcinoma (HCC). Methods: A review and critical analysis using the CASP guide, PubMed, Embase databases for years 2015 -2020 was carried out. A search for systematic reviews and meta-analyzes was performed using the terms “Ablation techniques” OR “radiofrequency” AND “Hepatectomy” AND “resection” AND “Carcinoma”, Hepatocellular ”AND“ hepatocellular carcinoma ”AND“ Early Stage”. Results: Four meta-analyzes were selected. The systematic review carried out by Xu et al, included HCC patients with stage 0 and A according to BCLC staging. The relative risk (RR) for overall survival was 1.39 at 1 year (95% CI = 0.36-5.33, p = 0.63); RR=1.40 at 3 years (95% CI=0.75-2.62, p = 0.29); 1.91 at 5 years (95% CI=1.32-2.79; p = 0.001). The RR for overall recurrence rate in both groups was 1.36 (95% CI=1.13-1.62; p = 0.0009). The study of Yin et al. included patients with HCH in initial stage BCLC 0, a Hazar ratio (HR) for survival was 0.99 (95% CI=0.39-2.54; p = 0.99, I2 = 0%); at 3 years: HR 0.64 (95% CI=0.41-1.00; p = 0.05, I2 = 0%); at 5 years: HR 0.63 (95% CI=0.42-0.95; p = 0.03, I2 = 0%). On the other hand, Majumdar et al. demonstrated that mortality (> 1 year) was lower in the surgery group than in the radiofrequency ablation group with OR 0.39 (95% CI =0.22-0.68). The recurrence rate was lower in the surgery group with 41.2% compared to the radiofrequency ablation group (56.9%) (OR 0.53; 95% CI=0.35 -0.78). In the last study He et al included HCC patients with initial stages where relative risk (RR) of overall survival at 3 years was 0.90 (95% CI: 0, 83–0.98, p = 0.01, I2 54%) and 0.84 at 5 years (95% CI: 0.75– 0.95, p = 0.004 I2 50%) in favor of HR. In addition, in early HCC stages, the overall survival rate at 3 years showed RR= 0.9 (95% CI = 0.88 - 0.98; p = 0.003, I2 59%) and RR=0.84 at 5 years (95% CI=0.75-0.94); p = 0.002, I2 76%). Conclusion: The effectiveness of RFA is comparable to LR regarding short-term survival rates, however, a greater recurrence rate is observed in patients treated with RFA.