Percutaneous treatment versus hepatic resection for the treatment of small hepatocellular carcinoma

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Published Jul 21, 2015
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Vol. 93 No. 3 (2015): Issue Mar 2015

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Hefaiedh Rania
Sabbeh Mariem
Ennaifer Rym
Romdhane Hayfa
Ben Nejma Houda
Belhadj Najet
Gharbi Lassad
Khalfallah Mohamed Tahar

Abstract

Background: Hepatocellular carcinoma is the first liver tumor worldwide. Therefore, it is a matter of debate whether surgical treatment or percutaneous treatment should be preferred for the treatment of patients with small hepatocellular carcinoma. The aim of our study was to compare the long-term outcome and the survival between surgically and percutaneously treated small hepatocellular carcinomas.
Material and methods: A retrospective study was performed in the department of hepatology during a period of 2009-2012. The study included all patients carrying small hepatocellular carcinoma which were divided in: group 1 including patients who underwent surgical treatment, and group 2 including patients who underwent percutaneous treatment.
Results: Among the 63 patients who were diagnosed for hepatocellular carcinoma, 28 carried a small hepatocellular carcinoma with a mean age of 63 years and sex-ratio of 0.64. Etiology of cirrhosis was viral in 96% cases. Surgical treatment (hepatic resection) was performed in 54% cases while percutaneous treatment was proposed for 46%: radiofrequency ablation in 69% and alcoholic injection in 31%. No major complications for both surgical and percutaneous treatment occurred in our study. The corresponding 6 months and 1- year overall survival rates for the surgical resection group and the percutaneous treatment group were 100%, 100%, 20%, and 52%, respectively (p=0,04). The disease free survival were not significantly different.
Conclusion: Our results showed the efficacy and safety of percutaneous ablation treatments (radiofrequency ablation and ethanol injection) in patients with small hepatocellular carcinoma.

Keywords:

Liver cancer - Surgery - Radiofrequency ablation - Alcoholic injection - Survival

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References

  1. Parkin DM, Bray F, Ferlay J, Pisani P. Global cancer statistics, 2002. CA Cancer J Clin 2005;55:74-108
  2. European Association For The Study Of The Liver; European Organisation For The Study Of The Liver. EASL-EORTC Clinical Practice Guidelines: Management of hepatocellular carcinoma. J Hepatol 2012;56:908-43
  3. Llovet JM, Brú C, Bruix J. Prognosis of hepatocellular carcinoma: the BCLC staging classification. Semin Liver Dis 1999;19:329-38
  4. Lau WY, Leung TW, Yu SC, Ho SK. Percutaneous local ablative therapy for hepatocellular carcinoma: a review and look into the future. Ann Surg 2003;237:171-9
  5. Bruix J, Sherman M; Practice Guidelines Committee, American Association for the Study of Liver Diseases. Management of hepatocellular carcinoma. Hepatology 2005,42: 1208-36
  6. Llovet JM, Di Bisceglie AM, Bruix J, et al. Design and endpoints of clinical trials in hepatocellular carcinoma. J Natl Cancer Inst 2008;100:698-711
  7. Concejero A, Chen CL, Wang CC, et al. Living donor liver transplantation for hepatocellular carcinoma: a single-center experience in Taiwan. Transplantation 2008;85:398-406
  8. Montorsi M, Santambrogio R, Bianchi P, et al. Survival and recurrences after hepatic resection or radiofrequency for hepatocellular carcinoma in cirrhotic patients: a multivariate analysis. J Gastrointest Surg 2005; 9: 62-7; discussion 67-8
  9. Hung HH, Chiou YY, Hsia CY, et al. Survival rates are comparable after radiofrequency ablation or surgery in patients with small hepatocellular carcinomas. Clin Gastroenterol Hepatol 2011;9:79-86
  10. Livraghi T, Meloni F, Di Stasi M, et al. Sustained complete response and complications rate after radiofrequency ablation of very early hepatocellular carcinoma in cirrhosis: is resection still the treatment of choice? Hepatology 2008;47:82-9.
  11. Chen MS, Li JQ, Zheng Y, et al. A prospective randomized trial comparing percutaneous local ablative therapy and partial hepatectomy for small hepatocellular carcinoma. Ann Surg 2006 ;243:321-8
  12. Lü MD, Kuang M, Liang LJ, et al. Surgical resection versus percutaneous thermal ablation for early-stage hepatocellular carcinoma: a randomized clinical trial. Zhonghua Yi Xue Za Zhi 2006;86:801-5.
  13. Hasegawa K, Makuuchi M, Takayama T, et al. Surgical resection vs. percutaneous ablation for hepatocellular carcinoma: a preliminary report of the Japanese nationwide survey. J Hepatol 2008;49:589-94.
  14. Lau WY, Leung TW, Yu SC, Ho SK. Percutaneous local ablative therapy for hepatocellular carcinoma: a review and look into the future. Ann Surg 2003;237:171-9.
  15. Seror O, N'Kontchou G, Tin Tin Htar M, et al. Ethanol versus radiofrequency ablation for the treatment of small hepatocellular carcinoma in patients with cirrhosis: a retrospective study of efficacy and cost. Gastroenterol Clin Biol 2006;30:1265-73
  16. Brunello F, Veltri A, Carucci P, et al. Radiofrequency ablation versus ethanol injection for early hepatocellular carcinoma: A randomized controlled trial. Scand J Gastroenterol 2008;43:727-35
  17. Shen A, Zhang H, Tang C, et al. A systematic review of radiofrequency ablation versus percutaneous ethanol injection for small hepatocellular carcinoma up to 3 cm. J Gastroenterol Hepatol 2013;28:793-800
  18. Shiina S, Teratani T, Obi S et al. Percutaneous ethanol injection therapy for liver tumors. Eur J Ultrasound 2001;13:95-106.
  19. Sasaki A, Kai S, Iwashita Y, Hirano S, Ohta M, Kitano S. Microsatellite distribution and indication for locoregional therapy in small hepatocellular carcinoma. Cancer 2005; 103: 299-306
  20. Ueno S, Tanabe G, Nuruki K, et al. Prognosis of hepatocellular carcinoma associated with Child class B and C cirrhosis in relation to treatment: a multivariate analysis of 411 patients at a single center. J Hepatobiliary Pancreat Surg 2002;9:469-77
  21. Chen YL, Ko CJ, Chien SY, et al. Tumor size as a prognostic factor in resected small hepatocellular carcinoma: a controversy revisited. J Gastroenterol Hepatol 2011;26:851-7
  22. Yaghi C, Sharara AI, Rassam P, et al. Hepatocellular carcinoma in Lebanon: Etiology and prognostic factors associated with short-term survival. World J Gastroenterol 2006;12:3575-80
  23. Poon RT, Fan ST. Hepatectomy for hepatocellular carcinoma: patient selection and postoperative outcome. Liver Transpl 2004;10:S39-45.