Percutaneous Radiofrequency Ablation Group Research Articles

Comparison of laparoscopic hepatectomy and percutaneous radiofrequency ablation for the treatment of small hepatocellular carcinoma: a meta-analysis

AimThe purpose of this study was to compare the long-term outcomes of laparoscopic hepatectomy (LH) and percutaneous radiofrequency ablation (PRFA) for the treatment of small hepatocellular carcinoma.MethodsWe systematically searched PubMed, Embase, Web of Science, and Medline from January 2000 to May 2022 for literature comparing the efficacy of LH and PRFA in the treatment of small hepatocellular carcinoma (largest tumour diameter ≤ 3 cm, number of intrahepatic tumours ≤3, or diameter of a single intrahepatic lesion ≤5 cm.). We assessed overall survival (OS), recurrence-free survival (RFS), local recurrence and complication rates.ResultsA total of 1886 patients with small HCC were included in the 8 studies included in this study, of which 839 underwent LH and 1047 underwent PRAF. The results of the meta-analysis showed that the two groups had the same 3-year (HR: 0.99, 95% CI: 0.67 to 1.47) and 5-year (HR: 1.30, 95% CI: 0.90 to 1.87) OS rates, and the LH group had better 3-year (HR: 0.58, 95% CI: 0.49 to 0.68) and 5-year (HR: 0.56, 95% CI: 0.37 to 0.85) RFS rates. The LH group had a lower local recurrence rate (OR: 0.19, 95% CI: 0.12 to 0.32), but the PRFA group had a lower complication rate (OR: 2.49, 95% CI: 1.76 to 3.54).ConclusionThere was no difference in OS between LH and PRFA in the treatment of small HCC. LH had a higher RFS rate and a lower local recurrence rate, but PRFA had a lower complication rate. In general, the long-term efficacy of LH in the treatment of small HCC is better than that of PRFA. Considering the advantages of less trauma and a low complication rate of PRFA, a large number of RCT studies are needed for further verification in the future.

Percutaneous radiofrequency ablation and endoscopic neurotomy for lumbar facet joint syndrome: are they good enough?

Lumbar facet joint (LFJ) syndrome is one of the common causes of low back pain (LBP). There are different views on percutaneous and endoscopic radiofrequency. The purpose of this systematic review and meta-analysis is to explore the therapeutic effect of radiofrequency ablation on LBP originating from LFJ and compare the therapeutic effect of percutaneous radiofrequency ablation and endoscopic neurotomy. We included randomized controlled trials which compared the efficiency of percutaneous radiofrequency ablation and conservative treatment (sham procedures, facet joint injection, physiotherapy, exercise, or oral medication) or compared the efficiency of percutaneous radiofrequency ablation and endoscopic neurotomy for LFJ syndrome. We searched in PubMed and Web of Science from inception to March 27, 2023. Meta-analysis was performed using RevMan 5.4 software. A total of 11 randomized controlled trials were included. Among them, nine studies were used for evaluating efficiency of percutaneous radiofrequency ablation, and two studies were used for evaluating efficiency of endoscopic neurotomy. Pooled data from two studies reporting outcomes at 1year did not show a benefit from facet joint denervation by comparing the percutaneous radiofrequency ablation and conservative treatment (standardized mean difference (SMD) = -0.87, 95% confidence interval (CI) [-2.10, 0.37], P = 0.17). There was no significant difference between percutaneous radiofrequency ablation and endoscopic neurotomy at 1-month follow-up (mean difference (MD) = -0.13, 95%CI [-0.18, -0.44], P = 0.41). At 12-month follow-up the pain relief in the endoscopic neurotomy was significantly better than that in the percutaneous radiofrequency ablation group (MD = 1.98, 95%CI [1.60, 2.36], P < 0 .0001). The LBP was significantly relieved shortly after percutaneous radiofrequency ablation. Compared with percutaneous radiofrequency ablation, endoscopic neurotomy seems to have a longer effect. A longer follow-up period is needed to confirm its effectiveness.

Comparison of laparoscopic radiofrequency ablation with percutaneous radiofrequency ablation in the treatment of chronic hepatitis B-related hepatocellular carcinoma involving specific sites: A retrospective cohort study

BackgroundThis study compared the effectiveness and safety of laparoscopic radiofrequency ablation (LRFA) and percutaneous radiofrequency ablation (PRFA) in the treatment of hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC) involving specific sites. MethodsThis retrospective cohort study included patients with HBV-related HCC involving specific sites treated with LRFA or PRFA between January 2012 and December 2020. The overall survival (OS), disease-free survival (DFS), and complications were compared between the LRFA and PRFA groups. The Cox proportional-hazards regression model was used to determine the factors affecting prognosis. ResultsThis study included 109 patients: 69 in the LRFA group and 40 cases in the PRFA group. No significant differences were found in the 3-year OS rate between the two groups (73.7% vs. 70.0%, P = 0.514), but the LRFA group showed a higher 3-year DFS rate than the PRFA group (58.2% vs. 42.5%, P = 0.018). The RFA method was not associated with OS but was independently associated with DFS (LRPA vs. PRFA, HR = 2.078, P = 0.012). The common complications were ascites, pleural effusion, and fever in the two groups. The occurrence of complications in patients treated with LRFA or PRFA was similar (15.9% vs. 12.5%, P = 0.785). ConclusionLRFA was associated with a better DFS in patients with HBV-related HCC involving specific sites. Thus, LRFA might have more advantages in treating liver cancer involving specific sites.

Outcomes of laparoscopic radiofrequency ablation versus percutaneous radiofrequency ablation for hepatocellular carcinoma.

Few studies have compared the therapeutic outcomes in patients with HCC who underwent laparoscopic radiofrequency ablation (LRFA) versus percutaneous radiofrequency ablation (PRFA) for hepatocellular carcinoma (HCC). Therefore, this study compared the recurrence and survival outcomes of the two RFA methods in patients with HCC. Recurrence and overall survival outcomes were evaluated in 307 patients who underwent LRFA (n = 151) or PRFA (n = 156) as a treatment method for de novo HCC. Inverse probability of treatment weighting (IPTW) analysis was performed to reduce the impact of treatment selection bias. There were no significant differences in major baseline characteristics between the LRFA and PRFA groups. However, the proportion of cirrhotic patients was higher in the LRFA group, whereas the LRFA group had more tumors and a more advanced tumor-node-metastasis stage. Moreover, the mean tumor size was significantly larger in the LRFA group than in the PRFA group. In a multivariate analysis, serum albumin level, more than three tumors, and the RFA method were identified as significant predictors of recurrence-free survival. Moreover, for the overall survival of HCC patients, serum albumin levels, days of hospital stay during RFA, and the RFA method were independent predictors. In the IPTW-adjusted analysis, the LRFA group showed significantly higher recurrence-free survival and overall survival. Our study revealed that compared with PRFA, LRFA was associated with longer recurrence-free survival and favorable overall survival in patients with HCC. Therefore, LRFA should be considered the primary therapy in patients with HCC eligible for RFA.

Laparoscopic radiofrequency ablation versus percutaneous radiofrequency ablation for subphrenic hepatocellular carcinoma.

PurposeRadiofrequency ablation is a curative treatment option for very early-stage or early-stage hepatocellular carcinoma (HCC). However, percutaneous radiofrequency ablation (PRFA) for subphrenic tumors is technically challenging. Laparoscopic radiofrequency ablation (LRFA) has been used to overcome this disadvantage. This study compared the treatment outcomes between LRFA and PRFA for subphrenic HCC.MethodsThis retrospective study screened patients who underwent PRFA or LRFA for subphrenic HCC between 2013 and 2018. Therapeutic outcomes, including local tumor progression (LTP), intrahepatic distant recurrence (IDR), extrahepatic metastasis (EM), disease-free survival (DFS), and overall survival (OS), were compared between the two groups.ResultsThirty patients in the PRFA group and 23 patients in the LRFA group were included. LTP was observed in six patients in the PRFA group (20%), but in no patients in the LRFA group. The cumulative LTP rates at 1, 3, and 5 years were 3.7%, 23.4%, and 23.4%, respectively, in the PRFA group and 0.0% in the LRFA group (P=0.015). The IDR, EM, and DFS rates were not significantly different between the two groups (P=0.304, P=0.175, and P=0.075, respectively). The OS rates at 1, 3, and 5 years were 96.6%, 85.7%, and 71.6%, respectively, in the PRFA group and 100%, 95.7%, and 95.7%, respectively, in the LRFA group (P=0.049).ConclusionLRFA demonstrated better therapeutic outcomes than did PRFA for subphrenic tumors in terms of LTP and OS. Therefore, LRFA can be considered as the first-line treatment option for subphrenic HCC.

CT-guided percutaneous minimally invasive radiofrequency ablation for the relief of cancer related pain from metastatic non-small cell lung cancer patients: a retrospective study.

Radiofrequency ablation (RFA) is the current gold standard for palliative care of non-small cell lung cancer (NSCLC). Pain relief for advanced metastases of NSCLC is notoriously difficult. Combined RFA therapy may be more effective than palliating therapy alone in management of painful metastatic disease. The effects of RFA on quality of life, particularly pain, as well as long-term outcome studies are not well studied. To study the effectiveness of percutaneous minimal invasive RFA in pain management of NSCLC patients with metastatic chest wall, vertebral bodies and rib, and periphery lung nodule. Forty patients with 59 tumors underwent percutaneous computed tomography (CT) or ultrasound-guided RFA for pain management over a 4-week observation. Forty patients were referred to ablation because of persistent severe pain despite using analgesics, chemotherapy or radiotherapy. The tumors were located in the periphery lung, or metastatic to chest wall, rib or vertebral body. Quantitative pain scale values were quantified on a 0-10 scale before, 24 hours, 72 hours, and 4 weeks after RFA. On the basis of changes in pain score and pain medication use, pain was reported with a composite measure as complete, partial, or no pain response. The overall survival (OS) rate was also collected and calculated with Kaplan-Meier method. After 4-week follow-up, complete pain relief (pain scale score ≤1) was observed in 12 patients (30%) and partial pain relief (pain scale score ≤3) in 15 (37.5%) patients; pain relief did not occur in 13 patients (32.5%). There was a significant decrease in pain at 24-hour, 72-hour, and 4-week follow-up compared with pain level at baseline (P<0.01). Opiate use was decreased in 92.5% (37/40) patients, remained unchanged in 7.5% (3/40) at 4 weeks follow-up. There are minor adverse events caused by RFA therapy, including pleural effusion (5/40), post procedural infections (3/40), pneumothorax (2/40) which resolved spontaneously. The OS rates at 6 months in the percutaneous RFA group were 60%, with average OS of 6.5 months in the further follow-up. Percutaneous RFA resulted in sustained pain relief from in most advanced NSCLC patients with intractable pain and resistant to chemotherapy or radiotherapy. The effect of RFA was satisfactory, and patients can obtain a better life quality with less pain and complications.

S0008 Palliative Endoscopic Biliary Radiofrequency Ablation Compared to Percutaneous Biliary Radiofrequency Ablation: A Meta-Analysis on Survival Outcomes

INTRODUCTION: Cholangiocarcinoma (CCA) is a malignant gastrointestinal tumor associated with very poor survival outcomes. 5-year survival rates have been reported as low as 2–5% with a median survival of 3–6 months for patient with unresectable disease. Apart from chemotherapy, palliation relies heavily on intraductal stenting, which provides little survival advantage. Endoscopic (ERFA) and percutaneous radiofrequency ablation (PRFA) deliver thermal energy at the tumor site resulting in a coagulative necrosis and cellular death. The study aims to compare survival outcomes in patients undergoing ERFA with those undergoing PRFA for palliation of unresectable CCA. METHODS: A literature review was conducted using the PubMed database for published manuscripts and abstracts comparing survival data in patients undergoing ERFA and PRFA for unresectable CCA. Studies analyzing post-surgical lesions, recurrent lesions, or non-CCA specific survival were excluded from our analysis. Pooled survival data was used to generate a Kaplan Meier curve with log-rank test performed to compare survival outcomes among the two groups. RESULTS: A total of 23 studies were included in our quantitative analysis. 14 of these studies analyzed survival outcomes in patients undergoing palliative ERFA (213 patients) and the other 9 studies analyzed the survival data of patients undergoing palliative PRFA (114 patients) for untreated, unresectable cholangiocarcinoma. The mean survival of the ERFA group (12.0 ± 5.1 months) compared to the mean survival of the PRFA group (14.3 ± 7.5 months) was noted to be significantly different, favoring PRFA (difference = 2.3 ± 0.7 months, 95% CI 0.9–3.7, P = 0.001). However, no significant difference was noted on the Kaplan-Meier curve plotting longitudinal survival of ERFA (median: 12.0 months) and PRFA (median: 10.8 months, log-rank test z = 0.7 P = 0.5). CONCLUSION: Biliary RFA may be a viable, palliative option for patients who have untreated, unresectable cholangiocarcinoma with overall survival data exceeding that of published cholangiocarcinoma survival data. Our meta-analysis demonstrated a slight advantage for PRFA when comparing mean survival outcomes to ERFA, but there is no meaningful difference in longitudinal survival outcomes as demonstrated by the KM curve. However, given the absence of studies directly comparing ERFA with PRFA, further studies comparing the modalities are needed.Figure 1.: Forest Plot of survivals among patients treated with ERFA and PRFA for previously untreated, unresectable cholangiocarcinoma.Figure 2.: Kaplan-Meier survival curve comparing patients treated with ERFA and PRFA for previously untreated, unresectable cholangiocarcinoma.

S0007 Palliative Endoscopic Biliary Radiofrequency Ablation and Percutaneous Biliary Radiofrequency Ablation as Therapies for Patients With Unresectable Cholangiocarcinoma: A Meta-Analysis on Overall Survival Outcomes

INTRODUCTION: Cholangiocarcinoma (CCA) has an extremely poor prognosis with literature demonstrating 5-year survival rates between 2 and 25% and median survival between 3 and 6 months for unresectable disease. Up to 80% of patients presenting with CCA have unresectable disease and these patients are left with palliative treatment options. Mainstay palliative therapy (apart from systemic chemotherapy) includes percutaneous or endoscopic stenting, however these treatment options have a relatively poor survival benefit. Radiofrequency ablation is a relatively new technology that delivers thermal energy at the tumor site resulting in locoregional coagulative necrosis. This meta-analysis aims to compare survival data for patients who underwent endoscopic radiofrequency ablation (ERFA) or percutaneous radiofrequency ablation (PRFA) as a palliative therapy for unresectable CCA. METHODS: A PubMed search was conducted for manuscripts and abstracts that analyzed survival outcomes in patients undergoing either ERFA or PRFA for the treatment of unresectable CCA. Studies were included in the meta-analysis only if extrapolation of CCA specific survival was made available. Studies analyzing post-surgical disease or recurrent lesions were excluded. A Kaplan Meier curve was generated from pooled survival data and a Forest plot compiled for comparison of mean survival between studies. RESULTS: There were 23 total studies that met our criteria and included in quantitative analysis. 14 studies analyzed ERFA and the survival outcomes of 213 patients. Additionally, 9 studies analyzed 114 patients and their survival outcomes after undergoing PRFA. One study included 30 patients undergoing either PRFA or ERFA. The mean survival of the ERFA group was 12.1 ± 4.4 months and mean survival of the PRFA group was 14.3 ± 7.5 months. The combined mean survival of all 357 patients undergoing palliative ERFA or PRFA was 12.8 ± 5.4 months. The median survival of the ERFA group was 12.0 months and the median survival of the PRFA group was 10.8 months. The overall median survival of all patients undergoing biliary RFA was 10.8 months. CONCLUSION: Biliary radiofrequency ablation seems to be reasonable for palliation in those with previously untreated, unresectable CCA with evidence of increased mean and median survivals relative to published data. However further studies are required to draw meaningful conclusions regarding survival benefit.Figure 1.: Forest Plot of mean survival of patients undergoing biliary RFA (ERFA and PRFA) for treatment of unresectable cholangiocarcinoma.Figure 2.: Kaplan-Meier survival curve of patients undergoing biliary RFA (ERFA and PRFA) for treatment of unresectable cholangiocarcinoma.

Comparison of the therapeutic outcomes between open plantar fascia release and percutaneous radiofrequency ablation in the treatment of intractable plantar fasciitis

BackgroundHeel pain is one of the most common complaints in foot and ankle clinic, and one of the leading causes of heel pain is plantar fasciitis.MethodsA retrospective analysis was carried out in 31 cases (39 feet) of patients with intractable plantar fasciitis. In the enrolled 26 cases, 16 patients (19 feet) received open plantar fascia release, and the other 15 patients (20 feet) received percutaneous radiofrequency ablation. The surgical results were assessed by visual analog scale (VAS) and American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Scale (AOFAS-AH) before and after surgery in all patients.ResultsAll 31 patients were followed up successfully, with a mean follow-up time of 58.77 months. There were no differences of patient’s demographics and characteristics information between the two groups. The average operative time of the feet in the open plantar fascia release is longer than that in the percutaneous radiofrequency ablation. Furthermore, the percutaneous radiofrequency ablation group had a shorter recovery time to normal activity than the open plantar fascia release group. There were no differences of postoperative VAS scores and the AOFAS-AH scores between the two groups. All patients reported satisfaction after either operation.ConclusionThe symptoms of pain and limb function were significantly improved in patients both of the partial plantar fascia release treated group and the percutaneous radiofrequency ablation treated group. The two types of surgical procedures shared the same long-term curative effects. However, percutaneous radiofrequency ablation was a better technique from the point of shorter operative time and postoperative recovery time.Trial registrationRetrospectively registered.

Long-term Effects of Repeat Hepatectomy vs Percutaneous Radiofrequency Ablation Among Patients With Recurrent Hepatocellular Carcinoma

Repeat hepatectomy and percutaneous radiofrequency ablation (PRFA) are most commonly used to treat early-stage recurrent hepatocellular carcinoma (RHCC) after initial resection, but previous studies comparing the effectiveness of the 2 treatments have reported conflicting results. To compare the long-term survival outcomes after repeat hepatectomy with those after PRFA among patients with early-stage RHCC. This open-label randomized clinical trial was conducted at the Eastern Hepatobiliary Surgery Hospital and the National Center for Liver Cancer of China. A total of 240 patients with RHCC (with a solitary nodule diameter of ≤5 cm; 3 or fewer nodules, each ≤3 cm in diameter; and no macroscopic vascular invasion or distant metastasis) were randomized 1:1 to receive repeat hepatectomy or PRFA between June 3, 2010, and January 15, 2013. The median (range) follow-up time was 44.3 (4.3-90.6) months (last follow-up, January 15, 2018). Data analysis was conducted from June 15, 2018, to September 28, 2018. Repeat hepatectomy (n = 120) or PRFA (n = 120). The primary outcome was overall survival (OS). Secondary outcomes included repeat recurrence-free survival (rRFS), patterns of repeat recurrence, and therapeutic safety. Among the 240 randomized patients (216 men [90.0%]; median [range] age, 53.0 [24.0-59.0] years), 217 completed the trial. In the intention-to-treat (ITT) population, the 1-year, 3-year, and 5-year OS rates were 92.5% (95% CI, 87.9%-97.3%), 65.8% (95% CI, 57.8%-74.8%), and 43.6% (95% CI, 35.5%-53.5%), respectively, for the repeat hepatectomy group and 87.5% (95% CI, 81.8%-93.6%), 52.5% (95% CI, 44.2%-62.2%), and 38.5% (95% CI, 30.6%-48.4%), respectively, for the PRFA group (P = .17). The corresponding 1-year, 3-year, and 5-year rRFS rates were 85.0% (95% CI, 78.8%-91.6%), 52.4% (95% CI, 44.2%-62.2%), and 36.2% (95% CI, 28.5%-46.0%), respectively, for the repeat hepatectomy group and 74.2% (95% CI, 66.7%-82.4%), 41.7% (95% CI, 33.7%-51.5%), and 30.2% (95% CI, 22.9%-39.8%), respectively, for the PRFA group (P = .09). Percutaneous radiofrequency ablation was associated with a higher incidence of local repeat recurrence (37.8% vs 21.7%, P = .04) and early repeat recurrence than repeat hepatectomy (40.3% vs 23.3%, P = .04). In subgroup analyses, PRFA was associated with worse OS vs repeat hepatectomy among patients with an RHCC nodule diameter greater than 3 cm (hazard ratio, 1.72; 95% CI, 1.05-2.84) or an α fetoprotein level greater than 200 ng/mL (hazard ratio, 1.85; 95% CI, 1.15-2.96). Surgery had a higher complication rate than did ablation (22.4% vs 7.3%, P = .001). No statistically significant difference was observed in survival outcomes after repeat hepatectomy vs PRFA for patients with early-stage RHCC. Repeat hepatectomy may be associated with better local disease control and long-term survival in patients with an RHCC diameter greater than 3 cm or an AFP level greater than 200 ng/mL. ClinicalTrials.gov identifier: NCT00822562.

Clinical application of laparoscopy-assisted and percutaneous radiofrequency ablation for hepatocellular carcinoma

To compared the efficacy of laparoscopy- assisted radiofrequency ablation (LRFA) and percutaneous radiofrequency ablation (PRFA) for the treatment of hepatocellular carcinoma (HCC). Between September, 2013 and September, 2016, a total of 60 HCC patients with 78 tumor nodules underwent LRFA (30 cases with 46 tumor nodules) and PRFA (30 cases with 32 tumor nodules) in our hospital. The patients were followed up for 3 years to compare the complete ablation rate, serious complications, recurrence rate and long-term survival rate between the two groups. The patients receiving LRFA had a complete ablation rate of 95.65% (44/46), significantly higher than the rate of 93.75% (30/32) in PRFA group (P &gt; 0.05). Significant differences were found between LRFA and PRFA groups in the incidence of serious complications [0 vs 6.7% (2/30), P &lt; 0.05] and recurrence rate [13.33% (4/30) vs 23.33% (7/30), P &lt; 0.05]. The 1-and 3-year overall survival rates of the patients were 96.15% and 55.12% in LRFA group and 93.73% and 48.54% in PRFA group, respectively (P &gt; 0.05). Both LRFA and PRFA are effective for HCC treatment, but is associated with a lower recurrence rate, fewer serious complications, a better treatment safety and a better applicability for tumor in difficult locations.

Retrospective study of CT-guided radiofrequency ablation and laparoscopic radiofrequency ablation in the treatment of recurrent small hepatocellular carcinoma against the diaphragmatic dome.

272 Background: Radiofrequency ablation (RFA) have been used to treat hepatocellular carcinoma (HCC) in the subphrenic area. Very few studies focus on ablation of recurrent small HCC against the diaphragmatic dome. The therapeutic safety, efficacy, and hospital fee have never been compared between CT guided RFA and laparoscopic RFA (L-RFA) either. Methods: CT guided RFA and L-RFA were performed in totally 116 patients with 151 local recurrent HCC lesions abutting the diaphragm. We compared major and minor postoperative complications, hospital stay and fee, overall survival (OS), and local tumor progression (LTP) between two groups for evaluating respective therapeutic efficacy and safety. Moreover, in CT-guided percutaneous RFA group, depending on the locations of recurrent HCC nodules differentiated puncture paths and ablation methods were used, and intraoperative complications were recorded. Results: There is no significant difference in OS and LTP between CT- guided RFA and LRFA.In recorded postoperative complications, the morbidity in CT-guided RFA group is lower than that of L-RFA group. The average safety margin is 8 and 11 mm in CT-guided RFA and LRFA group, respectively. The shoulder and back pain is significantly high in L-RFA group probably due to pneumoperitoneum. Moreover, overall hospital stay and cost is also lower in CT-guided RFA group. Conclusions: Both CT-guided RFA and L-RFA are considered to be an effective approach for recurrent small HCC abutting diaphragm. Particularly, CT-guided RFA is an easy and economic with less complications if suitable puncture paths and ablation methods can be applied.

The guidance value of indocyanine green test on small hepatocellular carcinoma operation selection

Objective To investigate the guidance value of indocyanine green test on the selection of small hepatocellular carcinoma operation. Methods The clinical data of 143 cases of small hepatocellular carcinoma who underwent indocyanine green test were collected. These patients have accepted liver resection or percutaneous radiofrequency ablation (PRFA). They were divided into liver resection group and RF group. On the basis of the occurrence of liver failure after operation, they were divided into liver failure group and non liver failure group again. There was a total of four groups. The clinical data of the four groups were compared, and the diffences in indocyanine green retention rate of 15 min (ICG-R15) and Child-Pugh (CP) grade were observed. Based on the variances of ICG-R15, the patients in liver resection group were streamed into three subgroups: (1) ICG-R15 30%. Meanwhile, the patients in PRFA group were divided into three subgroups: (1) ICG-R15 40%. Finally, the difference in hepatic failure rate was compared between different groups in the same operation mode. Results The differences were not statistically significant in the clinial data among four groups (P=0.732, P=0.686, P=0.863, P=0.748, P=0.862, P=0.732). However, the difference was statistically significant in ICG-R15 and CP grade (P=0.006, P=0.017, P=0.046, P=0.021). In the liver resection group, the rate of hepatic failure in ICG-R15 30% subgroup was 2.3%, 12.5% and 55.5% respectively. The difference was statistically significant between ICG-R15 30% subgroup (P=0.000). In the PRFA group, the rate of hepatic failure in ICG-R15 40% subgroup was 0, 11.1% and 66.7%. The difference was statistically significant between ICG-R15 40% subgroup (P=0.001). Conclusion The ICG -R15 are sensitive indicators to assess liver reserve function, which has the guiding value on the selection of operation mode of small liver cancer. Liver resection and radiofrequency ablation were all safe when ICG-R15 40%, radiofrequency ablation was not suitable and liver protection therapy was recommended. Decision of surgical plan was made after liver function to be improved. Key words: Small liver resection; Hepatectomy; Radiofrequency catheter ablation; Indocyanine green test; Child-Pugh classification

Percutaneous Radiofrequency Ablation versus Surgical Resection for the Treatment of Small Hepatic Carcinoma: A Meta-analysis

Aims: To evaluate the curative effect of percutaneous radiofrequency ablation (PRFA) versus surgical resection (SR) for the treatment of small hepatic carcinoma. Methods: Cochrane Library, Medline, Pubmed, CNKI, WanFang, VIP databases were searched from January 1990 to March 2013, then clinical control studies comparing curative effects of PRFA with SR in treatment of small hepatic carcinoma were acquired and reviewed. Qualities of these studies were evaluated. Publication bias was also assessed by using a funnel plot. Then primary outcomes, namely overall survival rates, disease-free survival rates and postoperative complication, were abstracted to conduct a combined analysis by using fixed or random effects model. Results: A total of eight studies involving 1287 patients were included in our study. The PRFA group has a lower overall survival rates over the SR group in 1 year (OR, 0.62; 95% confidence interval [CI], 0.43-0.89; P = 0.009), 3 years (OR, 0.44; 95% CI, 0.27-0.72; P=0.001), and 5 years (OR, 0.49; 95% CI, 0.35-0.68; P＜0.0001). The PRFA group has a lower disease-free survival rates over the SR group in 1 year (OR, 0.63; 95% CI, 0.49-0.82; P=0.0006), 3 years (OR, 0.45; 95% CI, 0.30-0.67; P=0.0001), and 5 years (OR, 0.46; 95% CI, 0.33-0.64; P＜0.00001). The postoperative complication of the PRFA group was lower than the SR group (OR, 0.21; 95% CI, 0.08-0.56; P＜0.00001). Conclusion: PRFA had lower overall survival rates after surgery and disease-free survival than SR, but it has a lower incidence of postoperative complications. Then PRFA, acted as an operation with smaller invasion and shorter hospitalization time, would be a good choice for the patients with hepatic carcinoma who is reluctant to be treated by SR.

Laparoscopic combined with percutaneous ablation for hepatocellular carcinoma under liver capsule: A single Chinese center experience of thirty patients.

For the tumor lesions close to capsule of the liver, traditional percutaneous radiofrequency ablation (PRFA) is limited due to high incidence of postoperative complications. The aim of the present study is to whether laparoscopic combined with PRFA (LCPR) could effectively ablate the tumor lesions close to capsule of the liver. A total of 119 patients with subcapsular hepatocellular carcinoma (HCC) were divided into two groups: PRFA group (89 patients) and LCPR group (30 patients). RFA was accomplished through cool-tip RFA system. For LCPR, PRFA was first carried out to destroy tumors deep inside the liver tissue. Then, laparoscopic RFA was performed under the guide of laparoscopic view and destroyed the superficial part of the tumor. Postoperative morbidity and technique effectiveness between two groups were evaluated. In PRFA group, the rate of fever was 70.8% (63/89), and two patients had gallbladder damage. Five patients had ascites. Pain was found in 26 patients (29.2%). In LCPR group, the rate of fever was 22/30 (73.3%). Two patients had ascites and only two patients complained of pain. In PRFA group, 77.5% (69/89) of the tumors were totally ablated, and in LCPR, 93.3% (28/30) of the tumors were destroyed without any residuals. LCPR could significantly reduce the incidence of postoperative pain and the rate of regional tumor residuals compared to the PRFA, suggesting this method could potentially be useful for subcapsular HCC ablation treatment.

Outcomes of laparoscopic hepatic resection versus percutaneous radiofrequency ablation for hepatocellular carcinoma located at the liver surface: A case-control study with propensity score matching.

Percutaneous radiofrequency ablation (P-RFA) therapy is a widely applied treatment for small hepatocellular carcinoma (HCC); however, local recurrence is a major issue of HCC located at the surface of the liver (surface HCC). The aim of this study was to compare the outcome of laparoscopic hepatic resection (LH) and P-RFA for surface HCC in case-control patient groups using the propensity score. Between 2011 and 2013, 40 and 52 patients underwent LH and P-RFA for surface HCC (≤3cm, 1-3 nodules). To correct the difference in clinicopathological factors between the two groups, propensity score matching was used at a 1:1 ratio, which resulted in a comparison of 27 patients/group. We compared outcomes between the two groups, with special reference to local recurrence. Clinicopathological variables were well balanced between the two groups. One patient in the LH group was converted to open surgery due to adhesion. The incidence of complications was 0% in the P-RFA group and 15% (four patients) in the LH group (P = 0.11); however, none of these four patients in the LH group sustained severe complications. The duration of hospitalization following treatment was longer in the LH group than in the P-RFA group (12.6 vs 7.6days, P <0.01). The incidence of local recurrence was lower in the LH group (0%) than in the P-RFA group (eight patients [30%], P = 0.004). LH is an effective treatment for surface HCC with regard to control of local recurrence.

Percutaneous Radiofrequency Ablation Versus Partial Hepatectomy for Small Centrally Located Hepatocellular Carcinoma

It is not known whether percutaneous radiofrequency ablation (PRFA) could get the same treatment efficacy and fewer complications as partial hepatectomy (PH) in patients with small centrally located hepatocellular carcinoma (HCC). The present study was designed to evaluate the efficacy of PH and PRFA in the treatment of small centrally located HCC. From January 2002 until December 2007, 196 patients with small centrally located HCC (≤5 cm) were included. Of these 196 patients, 94 received PRFA and 102 patients were treated with PH. Treatment outcomes, including major complications and survival data, were studied. No treatment-related death occurred in either group. There were no significant differences in survival rates between the two groups. The 1-, 3-, and 5-year disease-free survival rates for the PRFA and PH groups were 57.9%, 36.4%, 34.0%, and 59.8%, 42.4%, 40.8%, respectively (P = 0.50). The 1-, 3-, and 5-year overall survival rates for the two groups were 94.3%, 74.7%, and 49.8%, and 89.2%, 74.1%, and 63.1%, respectively (P = 0.96). PRFA had a lower rate of major complications than PH (8.5 vs. 19.6%), and the hospital stay was also shorter in the PRFA group than in the PH subgroup (4 vs. 13 days). Based on the data obtained, we concluded that PRFA might be equal to PH for the treatment of small centrally located HCC. However, PRFA has the benefits of shorter hospital stay as well as a lower rate of complications.

Single-center Comparison of Complications in Laparoscopic and Percutaneous Radiofrequency Ablation With Ultrasound Guidance for Renal Tumors

To report on postoperative complications associated with laparoscopic radiofrequency ablation (LRFA) and percutaneous radiofrequency ablation (PRFA) in a single-center experience. We conducted a retrospective review of medical records for patients undergoing LRFA or PRFA between February 2006 and March 2010 at our center. Demographics, radiographic variables, and complication rates were compared between the 2 groups. Risk factors for postoperative complications after operation were analyzed with multivariate logistic regression. Of a total 191 patients included in this study, 132 underwent LRFA and 59 underwent PRFA. There were no significant differences between the 2 groups with respect to age, gender, biopsy data, American Society of Anesthesiologists classification, body mass index, single kidney, tumor size, tumor number, glomerular filtration rate, follow-up, or RENAL nephrometry score. We observed complications in 16 LRFA procedures (12.1%) and 10 PRFA procedures (16.9%) (P = .369). There was no difference in the distribution of the complications between LRFA and PRFA groups. The complication (grades 1 and 2) rate in the LRFA group (7.6%) was not significantly different from that in the PRFA group (10.2%) (P = .550). The complication (grade 3a) rate in the LRFA group (4.5%) was not significantly different from that in the PRFA group (6.8%) (P = .522). A multivariate analysis disclosed that extra ablation time was the only predictor of postoperative complications. Significantly more anterior tumors were approached laparoscopically, and significantly more posterior tumors were approached percutaneously. Complication rate was not significantly different between LRFA and PRFA. Extra ablation time was a significant risk factor associated with postoperative complications.

Effects of percutaneous radiofrequency ablation and repeat hepatectomy for the treatment of solitary recurrent hepatocellular carcinoma with the diameter no more than 3 cm

Objective To compare the efficacy of percutaneous radiofrequency ablation (PRFA) and repeat hepatectomy for solitary recurrent hepatocellular carcinoma (HCC) with the diameter≤3 cm. Methods The clinical data of 151 patients with recurrent HCC (diameter≤3 cm) who were admitted to the Cancer Center of Sun Yat-Sen University from January 1999 to December 2009 were retrospectively analyzed. Of all the patients, 79received PRFA (PRFA group) and 72 received repeat hepatectomy (repeat hepatectomy group). The survival rate, morbidity and recurrence of the tumor between the two groups were compared. All data were analyzed using t test, chi-square test or Log-rank test, and the survival of the patients were analyzed using the Kaplan-Meier method. Results The mobidities of the PRFA group and repeat hepatectomy group were 13% (10/79) and 36%(26/72), respectively, with a significant difference between the two groups (x2=11.411, P＜0.05). The cumulative 1-, 2-, 3-, 4-, 5-year survival rates were 89.7%, 75.2%, 67.1%, 61.5%, 56.6% in the PRFA group, and 86.0%, 67.6%, 53.6%, 44.1%, 40.2% in the repeat hepatectomy group, with no significant difference between the two groups (x2=1.610, P＞0.05). The cumulative 4-, 5-year survival rates of the PRFA group were significant higher than those in the repeat hepatectomy group (x2=4.682, 4. 196, P ＜ 0.05). The local tumor recurrence rate of the PRFA group was 5% (4/79), and the incisal margin recurrence rate was 3% (2/72) in the repeat hepatectomy group, with no significant difference between the two groups (x2=0.565, P＞0.05). Conclusion As a less invasive treatment method, PRFA is superior to repeat hepatectomy for solitary recurrent HCC with the diameter≤3 cm. Key words: Hepatocellular carcinoma; Recurrence; Catheter ablation,radiofrequency; Hepatectomy; Efficacy analysis

Surgicalvspercutaneous radiofrequency ablation for hepatocellular carcinoma in dangerous locations

To compare the long-term outcome of percutaneous vs surgical radiofrequency ablation (RFA) for hepatocellular carcinoma (HCC) in dangerous locations. One hundred and sixty-two patients with HCC in dangerous locations treated with percutaneous or surgical RFA were enrolled in this study. The patients were divided into percutaneous RFA group and surgical RFA group. After the patients were regularly followed up for a long time, their curative rate, hospital stay time, postoperative complications and 5-year local tumor progression were compared and analyzed. No significant difference was observed in curative rate between the two groups (91.3% vs 96.8%, P=0.841). The hospital stay time was longer and more analgesics were required while the incidence of bile duct injury and RFA-related hemorrhage was lower in surgical RFA group than in percutaneous RFA group (P<0.05). The local progression rate of HCC in dangerous locations was significantly lower in surgical RFA group than in percutaneous RFA group (P=0.05). The relative risk of local tumor progression was 14.315 in percutaneous RFA group. The incidence of severe postoperative complications and local tumor progression is lower after surgical RFA than after percutaneous RFA.