Copyright
©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Mar 15, 2019; 11(3): 227-237
Published online Mar 15, 2019. doi: 10.4251/wjgo.v11.i3.227
Hepatic resection vs percutaneous radiofrequency ablation of hepatocellular carcinoma abutting right diaphragm
Kyoung Doo Song, Hyo Keun Lim, Hyunchul Rhim, Min Woo Lee, Tae Wook Kang, Yong Han Paik, Jong Man Kim, Jae-Won Joh
Kyoung Doo Song, Hyunchul Rhim, Min Woo Lee, Tae Wook Kang, Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, South Korea
Hyo Keun Lim, Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul 06351, South Korea
Yong Han Paik, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, South Korea
Jong Man Kim, Jae-Won Joh, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, South Korea
Author contributions: Song KD and Lim HK designed the study, analyzed data and wrote the manuscript; Lim HK, Rhim H, Lee MW, Paik YH, Joh JW and Kim JM were all responsible for the provision of study materials or patients; Kang TW and Kim JM contributed to collection and assembly of data; all authors provided critical review of the manuscript and approved the final version of the manuscript.
Institutional review board statement: This study was reviewed and approved by the Institutional Review Board of the Samsung Medical Center.
Informed consent statement: Informed consent was waived by the Institutional Review Board of the Samsung Medical Center because this study was a retrospective study.
Conflict-of-interest statement: All authors declare no conflicts of interest related to this article.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Hyo Keun Lim, MD, PhD, Professor, Department of Radiology and Department of Health Sciences and Technology, Samsung Medical Center, SAIHST, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, South Korea. hyokeun.lim@samsung.com
Telephone: +82-2-34102505 Fax: +82-2-34102559
Received: October 23, 2018
Peer-review started: October 23, 2018
First decision: November 29, 2018
Revised: December 12, 2018
Accepted: January 5, 2019
Article in press: January 6, 2019
Published online: March 15, 2019
BACKGROUND
It is usually difficult to adequately conduct percutaneous ultrasound-guided radiofrequency (RF) ablation for hepatocellular carcinomas (HCCs) abutting the diaphragm. Our hypothesis was that the subphrenic location of HCC could have an effect on the long-term therapeutic outcomes after hepatic resection and RF ablation.
AIM
To compare the long-term therapeutic outcomes of hepatic resection and percutaneous RF ablation for HCCs abutting the diaphragm.
METHODS
A total of 143 Child-Pugh class A patients who had undergone hepatic resection (n = 80) or percutaneous ultrasound-guided RF ablation (n = 63) for an HCC (≤ 3 cm) abutting the right diaphragm were included. Cumulative local tumor progression (LTP), cumulative intrahepatic distant recurrence (IDR), disease-free survival (DFS), and overall survival (OS) rates were estimated. Prognostic factors for DFS and OS were analyzed. Complications were evaluated.
RESULTS
The cumulative IDR rate, DFS rate, and OS rate for the hepatic resection group and RF ablation group at 5 years were “35.9% vs 65.8%”, “64.1% vs 18.3%”, and “88.4% vs 68.7%”, respectively. Hepatic resection was an independent prognostic factor for DFS (P ≤ 0.001; hazard ratio, 0.352; 95%CI: 0.205, 0.605; with RF ablation as the reference category); however, treatment modality was not an independent prognostic factor for OS. The LTP rate was 46.6% at 5 years for the RF ablation group. The major complication rate was not significantly different between the groups (P = 0.630). The rate of occurrence of peritoneal seeding was higher in the RF ablation group (1.3% vs 9.5%, P = 0.044).
CONCLUSION
Although OS was not significantly different between patients who had gone hepatic resection or percutaneous RF ablation for HCCs abutting the diaphragm, DFS was better in the hepatic resection group.
Core tip: The aim of this study was to compare the long-term therapeutic outcomes of hepatic resection and percutaneous radiofrequency (RF) ablation for hepatocellular carcinomas abutting the diaphragm. The disease-free survival (DFS) rate was 64.1% and 18.3% for the hepatic resection group and the RF ablation group, and overall survival (OS) rate was 88.4% and 68.7% for the hepatic resection group and the RF ablation group at 5 years. The local tumor progression rate was as high as 46.6% for the RF ablation group. Although OS was not significantly different between two groups, DFS was better in the hepatic resection group.
