Small HCC: minimally invasive surgery or radiofrequency ablation?

  • Si MB & al.
  • Surg Endosc
  • 11 Apr 2019

  • curated by Jim Kling
  • Univadis Clinical Summaries
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Takeaway

  • Minimally invasive liver surgery (MIS) was associated with better survival outcomes than radiofrequency ablation (RFA) in small hepatocellular carcinoma (HCC).
  • RFA was safer than MIS and may be a good choice for patients with a single nodule ≤3 cm.
  • These results come from a meta-analysis, but the overall level of evidence was low.

Why this matters

  • The study is the first meta-analysis comparing MIS and RFA in small HCC.

Study design

  • Meta-analysis of 6 studies (n=597): 4 studies examined percutaneous RFA, 2 laparoscopic RFA.
  • Funding: Various nonindustry sources.

Key results

  • There was no significant difference in 1-year OS.
  • The MIS group had better 3-year OS (OR, 0.55; P=.005).
  • Disease-free survival (DFS) was higher with MIS at 1 year (OR, 0.63; P=.04) and 3 years (OR, 0.51; P=.0005).
  • RFA was associated with a higher local recurrence rate (OR, 2.24; P=.0002).
  • RFA was associated with a lower frequency of treatment-related complications (OR, 0.34; P<.00001>
  • In a subanalysis of patients with tumors ≤3 cm, there was no significant difference in OS or DFS at 1 or 3 years.

Limitations

  • Data came from nonrandomized trials.

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