2004 Papers - Ogihara


Radiofrequency Ablation versus Surgical Resection for Single Nodule Hepatocellular Carcinoma: Long-term Outcomes

Makoto Ogihara, MD, Linda L Wong, MD, FACS, Junji Machi, MD, PhD, FACS
Department of Surgery, University of Hawaii School of Medicine

Background:Radiofrequency ablation (RFA) has been increasingly utilized for treatment of hepatocellular carcinoma (HCC). Long-term results of RFA, especially in comparison to surgical resection, have not been well described.

Methods: Eighty-seven patients with single nodule HCC underwent surgical resection (n=47) or RFA (n=40) during 9-year period. RFA was performed for 36 unresectable disease and four surgical refusals. Each group was further divided based on tumor size for analysis; Group 1: resection, ≤ 5 cm (n=18), Group 2: RFA, ≤ 5 cm (n=26), Group 3: resection, > 5 cm (n=29) and Group 4: RFA, > 5 cm (n=14). Follow up ranged from 2 to 72 months. Patients’ characteristics, local recurrences and overall and disease-free survivals were compared.

Results:Patients who underwent RFA were older (69 vs. 60, p=0.0006), had more advanced Child-Pugh class and TNM stage (p=0.0002 and p=0.016, respectively), and had smaller tumors (4.6 vs. 7.4 cm, p=0.0032). Local recurrence rates were 2% for resection and 10% for RFA (p=0.12). These local and other recurrences were subsequently treated with multimodal therapies as indicated. The median overall and disease-free survivals were equivalent both between Groups 1 and 2 (49 vs. 51 months, p=0.44, 36 vs. 22 months, p=0.84), and Groups 3 and 4 (47 vs. > 63 months, p=0.94, 28 vs. 20 months, p=0.67).

Conclusion:Although the groups were not completely comparable, this retrospective study suggests that RFA may offer equivalent long-term results to surgical resection for single nodule HCC when combined with multimodal treatments.