Surgical resection versus percutaneous radiofrequency ablation in the treatment of hepatocellular carcinoma on cirrhotic liver

Objective To compare the experience of two different Surgical Units in the treatment of hepatocellular carcinoma (HCC) on cirrhosis with resection or percutaneous radiofrequency ablation (RFA) respectively. Summary Background Data When allowed by the hepatic functional reserve, surgery is the therapy for HCC on cirrhosis; alternative treatments are proposed due to the high tumor recurrence rate after resection. RFA is being widely adopted to treat HCC. Methods Over a 4-year period 79 cirrhotics with HCC underwent resection in one Surgical Unit (group A) and another 79 had RFA at a different Unit (group B). Patient selection, operative mortality, hospital stay, 1- and 3-year overall and disease-free survival were analysed. Results Group A (surgery): mean follow-up was 28.9 ± 17.9 months; operative mortality was 3.8%, mean hospital stay 9 days; 1- and 3-year survival were respectively 83 and 65%. One- and three-year disease-free survival were 79 and 50%. Group B (RFA): mean follow-up was 15.6 ± 11.7 months. Mean hospital stay was 1 day (range 1-8). One- and three-year survival were 78 and 33%; one- and three-year disease-free survival were 60 and 20%. Overall and disease-free survival were significanly higher in group A (P=0.002 and 0.001). The advantage of surgery was more evident for Child-Pugh class A patients and for single tumors of more than 3 centimeters in diameter. Results were similar in two groups for Child-Pugh class B patients Conclusions RFA has still to be confirmed as an alternative to surgery for potentially-resectable HCCs.