JZUS - Journal of Zhejiang University SCIENCE

Journal of Zhejiang University SCIENCE B 2016 Vol.17 No.3 P.236-246

Comparison of laparoscopic hepatectomy, percutaneous radiofrequency ablation and open hepatectomy in the treatment of small hepatocellular carcinoma

Author(s): Chong Lai, Ren-an Jin, Xiao Liang, Xiu-jun Cai
Affiliation(s): Department of Surgery, Institute of Minimally Invasive Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou 310016, China; more
Corresponding email(s): clai8827@zju.edu.cn, caixiujunzju@163.com
Key Words: Hepatocellular carcinoma, Laparoscopic hepatectomy, Minimally invasive techniques, Open hepatectomy, Percutaneous radiofrequency ablation

Share this article to： More <<< Previous Article \|

Abstract: Objective: Three mainstream techniques—laparoscopic hepatectomy (LH), percutaneous radiofrequency ablation (pRFA), and open hepatectomy (OH)—were compared in this study, in terms of their efficacies in the treatment of small hepatocellular carcinoma (HCC). Methods: A comparative study was performed within a total of 94 patients diagnosed with small HCC in our hospital from 2005 to 2010, who underwent LH (28), RFA (33), or OH (33). They had either a single tumor lesion of less than or up to three nodules with diameters of less than each. Outcomes were carefully evaluated throughout a 3-year follow-up interval and statistically interpreted. Results: The pRFA group had a significantly lower disease-free survival rate compared with the two surgical groups (P=0.001) and significantly shorter overall survival (P=0.005), while the LH group and the OH group had no difference in survival results. For patients younger than 60 years old, surgical approaches offered a better long-term overall survival prognosis (P=0.008). There were no statistically significant differences among the three groups in overall survival for elderly patients (P=0.104). Conclusions: Among patients with small HCC, LH may provide better curative effects than pRFA without increasing complication rates. pRFA leads to faster recurrence than surgical resections. LH has similar therapeutic effects to OH and causes less trauma. For patients younger than 60 years old, LH may be the best curative treatment. Elderly patients may choose either surgery or pRFA.

腹腔镜肝切除术、经皮射频消融术及传统开放手术对小肝癌的治疗比较

目的：评估比较目前三种主流技术对小肝癌的治疗作用及对患者预后的影响。
创新点：首次同时比较两种手术技术和一种微创射频技术对小肝癌患者的治疗效果，并且将小肝癌患者通过年龄分层，获得最优的治疗选择，以期指导临床上更个性化及精准化的治疗方案。
方法：选取2005年至2010年间94例符合单个肿瘤直径小于5 cm或不超过3个肿瘤且每个肿瘤直径小于3 cm的小肝癌患者，分至3个治疗组，分别为腹腔镜肝切除组（28例）、经皮射频消融组（33例）和开放肝切除组（33例）。经过3年的跟踪随访，统计比较3组患者的疾病预后及相关指标。
结论：本研究中统计结果显示，经皮射频消融组的无瘤生存率和总生存率明显比两个手术组低（图2和3）。腹腔镜手术组和开放手术组的生存及预后情况无明显差异，而腹腔镜手术组的创伤和术后并发症率要低于开放手术组（表2）。本研究根据中心经验将全部患者以60岁进行年龄划分（图5和6）。对于60岁以下的小肝癌患者来说，手术的效果明显优于射频消融术，故应优先选择微创的腹腔镜肝切除术；60岁以上的小肝癌患者经射频治疗获得的生存结果与手术无显著差异，同时射频治疗具有创伤轻微、可重复、并发症少等优势，故可以酌情选择手术或射频治疗。

关键词：肝细胞性肝癌；腹腔镜肝切除术；经皮射频消融术；微创技术；开放肝切除术

Reference

[1]Asham, E.H., Kaseb, A., Ghobrial, R.M., 2013. Management of hepatocellular carcinoma. Surg. Clin. North Am., 93(6):1423-1450.

[2]Ayav, A., Germain, A., Marchal, F., et al., 2010. Radiofrequency ablation of unresectable liver tumors: factors associated with incomplete ablation or local recurrence. Am. J. Surg., 200(4):435-439.

[3]Benvegnù, L., Gios, M., Boccato, S., et al., 2004. Natural history of compensated viral cirrhosis: a prospective study on the incidence and hierarchy of major complications. Gut, 53(5):744-749.

[4]Fang, Y., Chen, W., Liang, X., et al., 2014. Comparison of long-term effectiveness and complications of radiofrequency ablation with hepatectomy for small hepatocellular carcinoma. J. Gastroenterol. Hepatol., 29(1):193-200.

[5]Fattovich, G., Stroffolini, T., Zagni, I., et al., 2004. Hepatocellular carcinoma in cirrhosis: incidence and risk factors. Gastroenterology, 127(5):S35-S50.

[6]Feng, Q., Chi, Y., Liu, Y., et al., 2015. Efficacy and safety of percutaneous radiofrequency ablation versus surgical resection for small hepatocellular carcinoma: a meta-analysis of 23 studies. J. Cancer Res. Clin. Oncol., 141(1):1-9.

[7]Feng, Z., 2013. Minshan Chen: combination of TACE and RFA can improve the treatment of HCC. Ann. Transl. Med., 1(1):10.

[8]Gu, L., Liu, H., Fan, L., et al., 2014. Treatment outcomes of transcatheter arterial chemoembolization combined with local ablative therapy versus monotherapy in hepatocellular carcinoma: a meta-analysis. J. Cancer Res. Clin. Oncol., 140(2):199-210.

[9]Kim, Y.S., Lee, W.J., Rhim, H., et al., 2010. The minimal ablative margin of radiofrequency ablation of hepatocellular carcinoma (>2 and <5 cm) needed to prevent local tumor progression: 3D quantitative assessment using CT image fusion. Am. J. Roentgenol., 195(3):758-765.

[10]Koffron, A.J., Auffenberg, G., Kung, R., et al., 2007. Evaluation of 300 minimally invasive liver resections at a single institution: less is more. Ann. Surg., 246(3):385-394.

[11]Lai, E.C.H., Tang, C.N., 2013. Radiofrequency ablation versus hepatic resection for hepatocellular carcinoma within the milan criteria—a comparative study. Int. J. Surg., 11(1):77-80.

[12]Lai, Q., Avolio, A.W., Lerut, J., et al., 2012. Recurrence of hepatocellular cancer after liver transplantation: the role of primary resection and salvage transplantation in east and west. J. Hepatol., 57(5):974-979.

[13]Liu, Z., Gao, F., Yang, G., et al., 2014. Combination of radiofrequency ablation with transarterial chemoembolization for hepatocellular carcinoma: an up-to-date meta-analysis. Tumour Biol., 35(8):7407-7413.

[14]Mulier, S., Ni, Y.C., Jamart, J., et al., 2005. Local recurrence after hepatic radiofrequency coagulation: multivariate meta-analysis and review of contributing factors. Ann. Surg., 242(2):158-171.

[15]Pearce, N.W., Di Fabio, F., Teng, M.J., et al., 2011. Laparoscopic right hepatectomy: a challenging, but feasible, safe and efficient procedure. Am. J. Surg., 202(5):e52-e58.

[16]Rao, A., Rao, G., Ahmed, I., 2012. Laparoscopic or open liver resection Let systematic review decide it. Am. J. Surg., 204(2):222-231.

[17]Santambrogio, R., Podda, M., Zuin, M., et al., 2003. Safety and efficacy of laparoscopic radiofrequency of hepatocellular carcinoma in patients with liver cirrhosis. Surg. Endosc. Other Interv. Tech., 17(11):1826-1832.

[18]Song, J., Wang, Y., Ma, K., et al., 2015. Laparoscopic hepatectomy versus radiofrequency ablation for minimally invasive treatment of single, small hepatocellular carcinomas. Surg. Endosc., online.

[19]Tanaka, M., Katayama, F., Kato, H., et al., 2011. Hepatitis B and C virus infection and hepatocellular carcinoma in china: a review of epidemiology and control measures. J. Epidemiol., 21(6):401-416.

[20]Verslype, C., van Cutsem, E., Dicato, M., et al., 2009. The management of hepatocellular carcinoma. Current expert opinion and recommendations derived from the 10th world congress on gastrointestinal cancer, barcelona, 2008. Ann. Oncol., 20(Suppl. 7):vii1-vii6.

[21]Zhu, A.X., 2012. Molecularly targeted therapy for advanced hepatocellular carcinoma in 2012: current status and future perspectives. Semin. Oncol., 39(4):493-502.

Open peer comments: Debate/Discuss/Question/Opinion

<1>

Similar articles

- Go to

腹腔镜肝切除术、经皮射频消融术及传统开放手术对小肝癌的治疗比较

Darkslateblue:Affiliate; Royal Blue:Author; Turquoise:Article

Reference