Editorial
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Nov 27, 2024; 16(11): 3400-3407
Published online Nov 27, 2024. doi: 10.4240/wjgs.v16.i11.3400
Benefits and drawbacks of radiofrequency ablation via percutaneous or minimally invasive surgery for treating hepatocellular carcinoma
Ching-Lung Hsieh, Cheng-Ming Peng, Chun-Wen Chen, Chang-Hsien Liu, Chih-Tao Teng, Yi-Jui Liu
Ching-Lung Hsieh, Department of Computer Science and Information Engineering, Feng Chia University, Taichung 40724, Taiwan
Ching-Lung Hsieh, Cheng-Ming Peng, Department of Surgery, Chung Shan Medical University Hospital, Taichung 40201, Taiwan
Cheng-Ming Peng, School of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan
Chun-Wen Chen, Department of Radiology, Taichung Armed Forces General Hospital, Taichung 406, Taiwan
Chun-Wen Chen, Department of Medical Imaging and Radiological Sciences, Central Taiwan University of Science and Technology, Taichung 406, Taiwan
Chun-Wen Chen, Department of Radiology, School of Medicine, National Defense Medical Center, Taipei 11490, Taiwan
Chang-Hsien Liu, Department of Medical Imaging, China Medical University Hsinchu Hospital and China Medical University, Hsinchu 302, Taiwan
Chang-Hsien Liu, Institute of Nuclear Engineering and Science, National Tsing Hua University, Hsinchu 300, Taiwan
Chih-Tao Teng, Department of Radiology, Nantou Hospital of the Ministry of Health and Welfare, Nantou 540, Taiwan
Chih-Tao Teng, Master’s Program of Biomedical Informatics and Biomedical Engineering, Feng Chia University, Taichung 407, Taiwan
Yi-Jui Liu, Department of Automatic Control Engineering, Feng Chia University, Taichung 407, Taiwan
Author contributions: Hsieh CL and Peng CM provided expertise and experience in minimally invasive surgery-radiofrequency ablation; Chen CW, Liu CH, and Teng CT contributed expertise in percutaneous-radiofrequency ablation; Liu YJ conducted a survey and reviewed relevant studies; Hsieh CL and Liu YJ drafted the manuscript; All authors have reviewed and approved the final version of the manuscript.
Supported by Feng Chia University/Chung Shan Medical University, No. FCU/CSMU 112-001 (to Peng CM and Liu YJ); Taiwan National Science and Technology Council, No. 111-2314-B-035-001-MY3; and Taichung Armed Forces General Hospital, No. 107A42.
Conflict-of-interest statement: Compal Electronics supported a minor portion to Cheng-Ming Peng and Yi-Jui Liu. The company had no role in the editorial design, data interpretation, or manuscript preparation. No additional personal fees or non-financial support were received. The other authors have no conflicts of interest to report.
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: https://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Yi-Jui Liu, PhD, Professor, Department of Automatic Control Engineering, Feng Chia University, No. 100 Wenhwa Road, Seatwen, Taichung 407, Taiwan. erliu@fcu.edu.tw
Received: June 3, 2024
Revised: June 29, 2024
Accepted: July 18, 2024
Published online: November 27, 2024
Processing time: 149 Days and 3.4 Hours
Abstract

The management of early stage hepatocellular carcinoma (HCC) presents significant challenges. While radiofrequency ablation (RFA) has shown safety and effectiveness in treating HCC, with lower mortality rates and shorter hospital stays, its high recurrence rate remains a significant impediment. Consequently, achieving improved survival solely through RFA is challenging, particularly in retrospective studies with inherent biases. Ultrasound is commonly used for guiding percutaneous RFA, but its low contrast can lead to missed tumors and the risk of HCC recurrence. To enhance the efficiency of ultrasound-guided percutaneous RFA, various techniques such as artificial ascites and contrast-enhanced ultrasound have been developed to facilitate complete tumor ablation. Minimally invasive surgery (MIS) offers advantages over open surgery and has gained traction in various surgical fields. Recent studies suggest that laparoscopic intraoperative RFA (IORFA) may be more effective than percutaneous RFA in terms of survival for HCC patients unsuitable for surgery, highlighting its significance. Therefore, combining MIS-IORFA with these enhanced percutaneous RFA techniques may hold greater significance for HCC treatment using the MIS-IORFA approach. This article reviews liver resection and RFA in HCC treatment, comparing their merits and proposing a trajectory involving their combination in future therapy.

Keywords: Percutaneous radiofrequency ablation; Minimally invasive surgery; Hepatocellular carcinoma; Intraoperative radiofrequency ablation; Contrast-enhanced ultrasound

Core Tip: This article reviews the role of liver resection and radiofrequency ablation (RFA) in the treatment of early-stage hepatocellular carcinoma (HCC), comparing their pros and cons and proposing a potential trajectory involving the combination of surgical resection and RFA in future therapy. Despite percutaneous RFA's advantages, its high recurrence rate compared to resection remains a challenge. Techniques like artificial ascites and imaging enhancements aim to improve percutaneous RFA's efficacy and reduce recurrence. Minimally invasive surgery with intraoperative RFA (MIS-IORFA) enhances RFA's precision and safety. Applying these refined techniques to MIS-IORFA could yield long-term benefits in HCC management.