Retrospective Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. May 14, 2021; 27(18): 2205-2218
Published online May 14, 2021. doi: 10.3748/wjg.v27.i18.2205
Radiofrequency ablation vs surgical resection in elderly patients with hepatocellular carcinoma in Milan criteria
Maria Conticchio, Riccardo Inchingolo, Antonella Delvecchio, Letizia Laera, Francesca Ratti, Maximiliano Gelli, Ferdinando Anelli, Alexis Laurent, Giulio Vitali, Paolo Magistri, Giacomo Assirati, Emanuele Felli, Taiga Wakabayashi, Patrick Pessaux, Tullio Piardi, Fabrizio di Benedetto, Nicola de'Angelis, Javier Briceño, Antonio Rampoldi, Renè Adam, Daniel Cherqui, Luca Antonio Aldrighetti, Riccardo Memeo
Maria Conticchio, Departement of Emergency and Trasplantation of Organs, General Surgery Unit “M. Rubino”, Policlinico di Bari, Bari 70124, Italy
Riccardo Inchingolo, Interventional Radiology Unit, "F. Miulli" General Regional Hospital, Acquaviva delle Fonti 70021, Italy
Antonella Delvecchio, Department of Emergency and Organ Transplantation, General Surgery Unit “M. Rubino”, University of Bari, Ceglie Messapica 70124, Italy
Letizia Laera, Department of Oncology, "F. Miulli" General Regional Hospital, Acquaviva delle Fonti 70021, Italy
Francesca Ratti, Department of Surgery, Univ Vita Salute San Raffaele, Milan 20132, Italy
Maximiliano Gelli, Department of Visceral and Oncological Surgery, Gustave Roussy Cancer Campus Grand Paris, Villejuif 94800, France
Ferdinando Anelli, Unit of Oncologic and Pancreatic Surgery, Hospital University Reina Sofía, Cordoba 14004, Spain
Alexis Laurent, Department of Digestive and Hepatobiliary Surgery, Henri Mondor University Hospital, Creteil 94000, France
Giulio Vitali, Department of Surgery, University of Geneva Hospitals, Geneva 44041, Switzerland
Paolo Magistri, Giacomo Assirati, Fabrizio di Benedetto, Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Modena 41124, Italy
Emanuele Felli, Institut de Recherche Contre les Cancers de l'Appareil Digestif, Strasbourg 67000, France
Taiga Wakabayashi, Department of Surgery, Keio University School of Medicine, Shinjuku-ku 160-8582, Japan
Patrick Pessaux, Hepato-Biliary and Pancreatic Surgical Unit, Nouvel Hôpital Civil, Strasbourg cedex 67091, France
Tullio Piardi, Department of Hepatobiliary, Pancreatic and Digestive Surgery, University Hospital Robert Debré of Reims, Reims 51100, France
Tullio Piardi, Hepatobiliary and Pancreatic Surgery Unit, General Surgery Departement, Troyes Hospital, Troyes Zip or Postal Code, France
Tullio Piardi, University of Champagne - Ardenne, Reims 51100, France
Nicola de'Angelis, Unit of Minimally Invasive and Robotic Digestive Surgery, "F. Miulli" General Regional Hospital, Acquaviva delle Fonti 70021, Italy
Javier Briceño, Department of General and Digestive Surgery, Reina Sofia University Hospital, Cordoba 14004, Spain
Antonio Rampoldi, Interventional Radiology Unit, Niguarda Hospital, Milan 20132, Italy
Renè Adam, Department of Surgery, Hopital Paul Brousse, Villejuif 94800, France
Daniel Cherqui, Hepatobiliary Center, Hopital Paul Brousse, Villejuif 94800, France
Luca Antonio Aldrighetti, Unit of Hepato-Pancreatic-Biliary Surgery, Univ Vita Salute San Raffaele, Milan 20132, Italy
Riccardo Memeo, Unit of Hepato-Pancreatic-Biliary Surgery, "F. Miulli" General Regional Hospital, Acquaviva delle Fonti 70021, Italy
Author contributions: All authors equally contributed to this paper with conception and design of the study, literature review and analysis, drafting and critical revision and editing, and final approval of the final version.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of “F. Miulli” General Regional Hospital.
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: All the authors are aware of the content of the manuscript and have no conflict of interest.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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/
Corresponding author: Riccardo Inchingolo, MD, Chief Doctor, Director, Doctor, Interventional Radiology Unit, "F. Miulli" General Regional Hospital, Via di Santeramo, Acquaviva delle Fonti 70021, Italy. riccardoin@hotmail.it
Received: February 1, 2021
Peer-review started: February 1, 2021
First decision: February 27, 2021
Revised: March 13, 2021
Accepted: April 21, 2021
Article in press: April 21, 2021
Published online: May 14, 2021
Processing time: 97 Days and 11.1 Hours
Abstract
BACKGROUND

Surgical resection and radiofrequency ablation (RFA) represent two possible strategy in treatment of hepatocellular carcinoma (HCC) in Milan criteria.

AIM

To evaluate short- and long-term outcome in elderly patients (> 70 years) with HCC in Milan criteria, which underwent liver resection (LR) or RFA.

METHODS

The study included 594 patients with HCC in Milan criteria (429 in LR group and 165 in RFA group) managed in 10 European centers. Statistical analysis was performed using the Kaplan-Meier method before and after propensity score matching (PSM) and Cox regression.

RESULTS

After PSM, we compared 136 patients in the LR group with 136 patients in the RFA group. Overall survival at 1, 3, and 5 years was 91%, 80%, and 76% in the LR group and 97%, 67%, and 41% in the RFA group respectively (P = 0.001). Disease-free survival at 1, 3, and 5 years was 84%, 60% and 44% for the LR group, and 63%, 36%, and 25% for the RFA group (P = 0.001).Postoperative Clavien-Dindo III-IV complications were lower in the RFA group (1% vs 11%, P = 0.001) in association with a shorter length of stay (2 d vs 7 d, P = 0.001).In multivariate analysis, Model for End-stage Liver Disease (MELD) score (> 10) [odds ratio (OR) = 1.89], increased value of international normalized ratio (> 1.3) (OR = 1.60), treatment with radiofrequency (OR = 1.46) ,and multiple nodules (OR = 1.19) were independent predictors of a poor overall survival while a high MELD score (> 10) (OR = 1.51) and radiofrequency (OR = 1.37) were independent factors associated with a higher recurrence rate.

CONCLUSION

Despite a longer length of stay and a higher rate of severe postoperative complications, surgery provided better results in long-term oncological outcomes as compared to ablation in elderly patients (> 70 years) with HCC in Milan criteria.

Keywords: Hepatocellular carcinoma; Milan criteria; Radiofrequency ablation; Surgical resection; Elderly patients; Propensity score matching

Core Tip: Surgical resection and radiofrequency ablation represent two possible strategy in treatment of hepatocellular carcinoma in Milan criteria. In order to evaluate which of the two therapeutic options can provide better short-term and oncological outcomes, we compared data from 10 European centers before and after propensity score matching. Despite a longer length of stay and a higher rate of severe postoperative complications, surgery provided better results in long-term oncological outcomes as compared to ablation.