Page 105 - Read Online

(e.g. percutaneous ethanol injection, microwave, RFA, Follow-ups were extremely difficult. Usually, when
and brachytherapy) may be effective and feasible in the patient feels improvement; he/she stops visiting
the treatment of HCC patients who are not suitable our outpatient clinic for follow-ups.
[16]
for resection. Among these, RFA may be beneficial
to more patients than the others because of its large In conclusion, surgical resection is preferred over RFA
coagulated necrosis, fewer treatment sessions, and for HCC-liver cirrhosis Child A patients with tumor sizes
higher survival rates. [17-20] Rare studies have evaluated the ≥ 3 cm. HCC-liver cirrhosis Child A patients with masses
results of treatment with RFA, by comparing it to liver < 3 cm have almost the same results as both surgery
resection. [21-23] and RFA. But in special cases such as central position
lesions, RFA is preferred over resection. Also the
There was no in-hospital mortality after resection. One- decision for management may be changed according to
and two-year survivals were 85% and 70% respectively in patients well. Surgical resection 1- and 2-year survival
our series. There was no in-hospital mortality after RFA. rates were better than those treated with RFA.
One- and two-year survival was 80% and 65%, respectively.
This finding agreed with Parisi et al. who concluded Financial support and sponsorship
[16]
that surgical resection improved the overall survival and Nil.
recurrence-free survival in comparison with RFA.
Conflicts of interest
Our results regarding masses < 3 cm matched with other There are no conflicts of interest.
results of Nishikawa et al. who found that in patients with
[24]
HCCs < 3 cm, there was no significant difference between REFERENCES
the two treatment groups in terms of overall survival. They 1. Cho YK, Kim JK, Kim WT, Chung JW. Hepatic resection versus
concluded that RFA was as effective as resection in the radiofrequency ablation for very early stage hepatocellular carcinoma:
treatment of single and small HCC, and was less invasive a Markov model analysis. Hepatology 2010;51:1284-90.
than surgery. Chen et al. suggests that RFA and surgery 2. Lee WS, Yun SH, Chun HK, Lee WK, Kim SJ, Choi SH, Heo JS,
[25]
have similar results in terms of overall survival and RFS Joh JW, Choi D, Kim SH, Rhim H, Lim HK. Clinical outcomes of
hepatic resection and radiofrequency ablation in patients with solitary
[21]
for single HCCs < 5 cm. Abu-Hilal et al. showed that colorectal liver metastasis. J Clin Gastroenterol 2008;42:945-9.
RFA should be considered as an acceptable alternative 3. Mulier S, Ruers T, Jamart J, Michel L, Marchal G, Ni Y. Radiofrequency
when surgery was not possible in small unifocal HCCs. ablation versus resection for resectable colorectal liver metastases:
time for a randomized trial? An update. Dig Surg 2008;25:445-60.
Therefore, RFA could be the first choice of treatment for 4. Tanaka S, Shimada M, Shirabe K, Taketomi A, Maehara S, Tsujita
single and small HCC. E, Ito S, Kitagawa D, Maehara Y. Surgical radiofrequency ablation
for treatment of hepatocellular carcinoma: an endoscopic or open
However, regarding masses more than 3 cm, our results 5. approach. Hepatogastroenterology 2009;56:1169-73.
Livraghi T, Mäkisalo H, Line PD. Treatment options in hepatocellular
agree with Huang et al. who reported that in treating carcinoma today. Scand J Surg 2011;100:22-9.
[22]
Child-Pugh A cirrhotic patients with a solitary HCC larger 6. El-Serag HB. Epidemiology of viral hepatitis and hepatocellular
than 3 cm but < 5 cm, or with two or three lesions each carcinoma. Gastroenterology 2012;142:1264-73.e1.
< 5 cm, surgical resection provided a better survival 7. de Lope CR, Tremosini S, Forner A, Reig M, Bruix J. Management of
HCC. J Hepatol 2012;56 Suppl 1:S75-87.
than RFA. 8. Guy J, Kelley RK, Roberts J, Kerlan R, Yao F, Terrault N.
Multidisciplinary management of hepatocellular carcinoma. Clin
RFA has some advantages compared with resection Gastroenterol Hepatol 2012;10:354-62.
such as: Being less invasive, having a relatively rapid 9. Kishi Y, Hasegawa K, Sugawara Y, Kokudo N. Hepatocellular
carcinoma: current management and future development-improved
recovery period, and short hospital stay. But it also has outcomes with surgical resection. Int J Hepatol 2011;2011:728103.
shortcomings, such as more frequent local recurrence 10. Bilimoria MM, Lauwers GY, Doherty DA, Nagorney DM, Belghiti
after treatment than resection. [26,27] J, Do KA, Regimbeau JM, Ellis LM, Curley SA, Ikai I, Yamaoka Y;
International Cooperative Study Group on Hepatocellular Carcinoma.
Underlying liver disease, not tumor factors, predicts long-term survival
Furthermore, the resection group indicated higher after resection of hepatocellular carcinoma. Arch Surg 2001;136:528-35.
incidences of complications compared with RFA. In 11. Hasegawa K, Kokudo N, Makuuchi M. Surgical management of
addition, resection has weaknesses such as a longer hepatocellular carcinoma. Liver resection and liver transplantation.
Saudi Med J 2007;28:1171-9.
hospital stay and a longer recovery period after 12. Yang JM. Recent advances and controversies in surgical management
operation. Our finding was in agreement with the study of hepatocellular carcinoma. Zhongguo Yi Xue Ke Xue Yuan Xue Bao
[28]
of Park et al. and Bruix et al. [29] 2008;30:378-80. (in Chinese)
13. Bryant R, Laurent A, Tayar C, van Nhieu JT, Luciani A, Cherqui D.
Liver resection for hepatocellular carcinoma. Surg Oncol Clin N Am
The study is based on a limited number of patients, 2008;17:607-33, ix.
however, our number are near other studies. [30,31] 14. Xu G, Zhang JH, Cheng GF, Cai Y, Miao Y. Meta-analysis of surgical

96 Hepatoma Research | Volume 2 | April 1, 2016