Surgical resection versus laparoscopic radiofrequency ablation in patients with hepatocellular carcinoma and child-pugh class a liver cirrhosis

Roberto Santambrogio, Enrico Opocher, Massimo Zuin, Carlo Selmi, Emanuela Bertolini, Mara Costa, Matteo Conti, Marco Montorsi

Research output: Contribution to journalArticle

52 Citations (Scopus)

Abstract

Background: This study compared two homogeneous groups of patients submitted to either surgical resection (HR) or laparoscopic radiofrequency ablation (LRFA) for the treatment of hepatocellular carcinoma (HCC). When compatible with the liver functional reserve, HR remains the treatment of choice for HCC, while LRFA seems to be a promising, less invasive alternative. We thus compared HR or LRFA for short- and long-term outcomes in patients with a single HCC nodule and Child-Pugh class A liver cirrhosis. Methods: We enrolled 152 cirrhotic patients out of 372 cases consecutively evaluated for HCC. Enrolled patients with similar baseline characteristics underwent HR (n = 78) or LRFA (n = 74), in both cases with intraoperative ultrasonography, and they were then followed for similar durations (mean ± standard deviation, 36.2 ± 23.5 months for HR vs. 38.2 ± 28.4 for LRFA). Outcomes included short- and long-term morbidity, HCC recurrence, and overall survival. Results: Short-term morbidity was far higher in the HR group while, during follow-up, HCC recurrence (mainly local) was more frequent in patients treated with LRFA. More importantly, baseline alfa-fetoprotein levels and early HCC recurrence after treatment greatly influenced overall survival, while the use of HR or LRFA did not predict it. On the other hand, HCC recurrence was found to be determined by the surgical approach and ultrasound characteristics of the tumor. Conclusions: Our data were obtained from a large number of HCC cases and support similar survival rates after HR or LRFA for single HCC nodules on Child-Pugh class A liver cirrhosis, despite a marked increase in HCC recurrence rates after LRFA.

Original languageEnglish (US)
Pages (from-to)3289-3298
Number of pages10
JournalAnnals of Surgical Oncology
Volume16
Issue number12
DOIs
StatePublished - Dec 2009
Externally publishedYes

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Liver Cirrhosis
Hepatocellular Carcinoma
Recurrence
Morbidity
Survival
alpha-Fetoproteins
Ultrasonography
Therapeutics
Survival Rate
Liver

ASJC Scopus subject areas

  • Surgery
  • Oncology

Cite this

Surgical resection versus laparoscopic radiofrequency ablation in patients with hepatocellular carcinoma and child-pugh class a liver cirrhosis. / Santambrogio, Roberto; Opocher, Enrico; Zuin, Massimo; Selmi, Carlo; Bertolini, Emanuela; Costa, Mara; Conti, Matteo; Montorsi, Marco.

In: Annals of Surgical Oncology, Vol. 16, No. 12, 12.2009, p. 3289-3298.

Research output: Contribution to journalArticle

Santambrogio, Roberto ; Opocher, Enrico ; Zuin, Massimo ; Selmi, Carlo ; Bertolini, Emanuela ; Costa, Mara ; Conti, Matteo ; Montorsi, Marco. / Surgical resection versus laparoscopic radiofrequency ablation in patients with hepatocellular carcinoma and child-pugh class a liver cirrhosis. In: Annals of Surgical Oncology. 2009 ; Vol. 16, No. 12. pp. 3289-3298.
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AU - Opocher, Enrico

AU - Zuin, Massimo

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AU - Bertolini, Emanuela

AU - Costa, Mara

AU - Conti, Matteo

AU - Montorsi, Marco

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N2 - Background: This study compared two homogeneous groups of patients submitted to either surgical resection (HR) or laparoscopic radiofrequency ablation (LRFA) for the treatment of hepatocellular carcinoma (HCC). When compatible with the liver functional reserve, HR remains the treatment of choice for HCC, while LRFA seems to be a promising, less invasive alternative. We thus compared HR or LRFA for short- and long-term outcomes in patients with a single HCC nodule and Child-Pugh class A liver cirrhosis. Methods: We enrolled 152 cirrhotic patients out of 372 cases consecutively evaluated for HCC. Enrolled patients with similar baseline characteristics underwent HR (n = 78) or LRFA (n = 74), in both cases with intraoperative ultrasonography, and they were then followed for similar durations (mean ± standard deviation, 36.2 ± 23.5 months for HR vs. 38.2 ± 28.4 for LRFA). Outcomes included short- and long-term morbidity, HCC recurrence, and overall survival. Results: Short-term morbidity was far higher in the HR group while, during follow-up, HCC recurrence (mainly local) was more frequent in patients treated with LRFA. More importantly, baseline alfa-fetoprotein levels and early HCC recurrence after treatment greatly influenced overall survival, while the use of HR or LRFA did not predict it. On the other hand, HCC recurrence was found to be determined by the surgical approach and ultrasound characteristics of the tumor. Conclusions: Our data were obtained from a large number of HCC cases and support similar survival rates after HR or LRFA for single HCC nodules on Child-Pugh class A liver cirrhosis, despite a marked increase in HCC recurrence rates after LRFA.

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