Casaccia M, Santori G, Bottino G, Diviacco P, Andorno E. Laparoscopic resection vs laparoscopic radiofrequency ablation for the treatment of small hepatocellular carcinomas: A single-center analysis. World J Gastroenterol 2017; 23(4): 653-660 [PMID: 28216972 DOI: 10.3748/wjg.v23.i4.653]
Corresponding Author of This Article
Marco Casaccia, Professor, Department of Surgery, IRCCS, San Martino University Hospital-IST, University of Genoa, Monoblocco XI piano, Largo Rosanna Benzi, 10, 16132 Genoa, Italy. marco.casaccia@unige.it
Research Domain of This Article
Surgery
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastroenterol. Jan 28, 2017; 23(4): 653-660 Published online Jan 28, 2017. doi: 10.3748/wjg.v23.i4.653
Laparoscopic resection vs laparoscopic radiofrequency ablation for the treatment of small hepatocellular carcinomas: A single-center analysis
Marco Casaccia, Gregorio Santori, Giuliano Bottino, Pietro Diviacco, Enzo Andorno
Marco Casaccia, Giuliano Bottino, Pietro Diviacco, Enzo Andorno, Department of Surgery, IRCCS, San Martino University Hospital-IST, University of Genoa, 16132 Genoa, Italy
Marco Casaccia, Gregorio Santori, Department of Surgical Sciences and Integrated Diagnostics, School of Medicine, University of Genoa, 16132 Genoa, Italy
Author contributions: Casaccia M designed the research providing intellectual content of critical importance to the work, and drafted the article; Santori G designed the research, performed the analysis, and revised the article; Bottino G collected data and drafted part of the article; Diviacco P drafted part of the article and revised it; Andorno E provided intellectual content of critical importance and made the final revision.
Institutional review board statement: This study didn’t require the approval by the Ethics Committee of the IRCCS - Azienda Ospedaliera Universitaria San Martino-IST of Genoa.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: We have no financial relationships to disclose.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Marco Casaccia, Professor, Department of Surgery, IRCCS, San Martino University Hospital-IST, University of Genoa, Monoblocco XI piano, Largo Rosanna Benzi, 10, 16132 Genoa, Italy. marco.casaccia@unige.it
Telephone: +39-010-5554539 Fax: +39-010-5556944
Received: November 16, 2016 Peer-review started: November 18, 2016 First decision: December 19, 2016 Revised: December 30, 2016 Accepted: January 4, 2017 Article in press: January 4, 2017 Published online: January 28, 2017 Processing time: 63 Days and 12 Hours
Abstract
AIM
To compare survival and recurrence after laparoscopic liver resection (LLR) and laparoscopic radiofrequency ablation (LRFA) for the treatment of small hepatocellular carcinoma (HCC).
METHODS
Between June 1, 2005 and November 30, 2010, 46 patients (62.26 ± 8.55 years old; female/male: 12/34) treated for small HCC were enrolled following strict criteria. Patients with better liver function and larger tumors were referred for LLR (n = 24), while those with poorer liver function and multiple tumors were referred for LRFA (n = 22), and they were then followed for similar durations (44.74 ± 21.3 mo for LLR vs 40.27 ± 30.8 mo for LRFA).
RESULTS
The LLR and LRFA groups were homogeneous with regard to age, sex, etiology of liver cirrhosis, and AFP levels. The overall survival (OS) and disease-free survival (DFS) probability was 0.354 and 0.260, respectively. A significantly higher OS was observed in the LLR group (LLR: 0.442; LRFA: 0.261; P = 0.048), whereas no statistical difference was found for DFS (LLR: 0.206; LRFA: 0.286; P = 0.205). In the LRFA group was treated a greater number of nodules (LLR: 1.41 ± 0.77; LRFA: 2.72 ± 1.54; P < 0.001). Cox regression analysis found the number of intraoperative HCC nodules as the unique variable statistically significant for OS (hazard ratio: 2.225; P < 0.001). The rank-hazard plot showed a steeper increase of relative hazard for intraoperative nodules > 2.
CONCLUSION
Our preliminary results confirm the superiority of hepatic resection on thermoablation in the treatment of small HCC in selected patients, when both approaches are made laparoscopically. LLR showed better results compared to LRFA in terms of OS. These data need to be confirmed by further studies on a larger number of patients.
Core tip: This is a retrospective study to evaluate and compare the oncological results of hepatic resection and thermoablation in the treatment of small hepatocellular carcinoma in selected patients, when both approaches are made laparoscopically. Our preliminary results confirm the superiority of laparoscopic liver resection compared to laparoscopic radiofrequency ablation in terms of overall survival. These data need to be confirmed by further studies on a larger number of patients.
