Surgery outperforms radiofrequency ablation as a treatment for small hepatocellular carcinomas

Here is my highlight form the October edition of  the journal HPB which suggests that there needs to be some use over the use of radio frequency ablation as an alternative to surgical resection for hepatocellular carcinoma.

Radiofrequency ablation (RFA) has emerged as a useful option for treating some patients with hepatocellular carcinoma (HCC) but exactly where it fits in the management options is less clear. The best results from RFA are predicted in patients with small tumours ❤ cm in diameter.

Miura and colleagues from the Medical College of Wisconsin have undertaken an analysis of outcomes from almost 3000 patients who either underwent surgical resection (SR) or RFA for HCC 3 cm or smaller in diameter. As might be expected from a non-randomised retrospective study there were some differences between the groups in terms of proportion with cirrhosis and alphafetoprotein levels (both higher in RFA group). In the overall analysis the resection group had a better unadjusted survival at 5 years of 67% compared with 55% for RFA. The group then applied propensity scoring to attempt to overcome the selection bias between the two groups and after matching the survival benefit of surgical resection was maintained at 54% overall 5 year survival compared with 37% for the RFA group. Other factors associated with adverse outcome for RFA included older patients and those with cirrhosis. A further analysis excluded patients who underwent ablation using non thermal techniques but again the disadvantage in survival from RFA remained evident.

The authors conclude that RFA is inferior to surgical resection and that treatment strategies should emphasize a surgical resection first approach reserving RFA for patients with HCC in whom surgery is either unsafe or not desired by the patient.



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