Brief Article
Copyright ©2010 Baishideng. All rights reserved
World J Gastroenterol. Jun 28, 2010; 16(24): 3056-3062
Published online Jun 28, 2010. doi: 10.3748/wjg.v16.i24.3056
Combined resection and radiofrequency ablation for multifocal hepatocellular carcinoma: Prognosis and outcomes
Tan To Cheung, Kelvin K Ng, Kenneth S Chok, See Ching Chan, Ronnie T Poon, Chung Mau Lo, Sheung Tat Fan
Tan To Cheung, Kelvin K Ng, Kenneth S Chok, See Ching Chan, Ronnie T Poon, Chung Mau Lo, Sheung Tat Fan, Department of Surgery, The University of Hong Kong, 102 Pok Fu Lam Road, Queen Mary Hospital, Hong Kong, China
Author contributions: Cheung TT performed data collection, analysis and interpretation and wrote the paper; Ng KK, Chok KS and Chan SC reviewed the paper; Poon RT designed and supervised the study; Lo CM and Fan ST supervised the study.
Correspondence to: Tan To Cheung, Associate Consultant, Department of Surgery, The University of Hong Kong, 102 Pok Fu Lam Road, Queen Mary Hospital, Hong Kong, China. tantocheung@hotmail.com
Telephone: +852-28553025 Fax: +852-28165284
Received: February 4, 2010
Revised: March 12, 2010
Accepted: March 19, 2010
Published online: June 28, 2010
Abstract

AIM: To analyze the combined treatment of resection and intraoperative radiofrequency ablation (RFA) for multifocal hepatocellular carcinoma in terms of prognosis and surgical outcomes.

METHODS: This study was a retrospective case comparison study using prospectively collected data. The study covered the period from April 2001 to December 2006. The data of 200 patients with histologically confirmed hepatocellular carcinoma were reviewed. Nineteen patients (17 men and 2 women) having received resection in combination with RFA were chosen as subjects of the study (the combination group). Fifty-four patients (43 men and 11 women) having received resection alone were selected for comparison (the resection group). The two groups matched tumor number and tumor size, and all the patients in the two groups displayed no tumor rupture, major vascular involvement and distant metastasis. Their demographics, preoperative assessment, disease recurrence patterns, overall survival and disease-free survival were compared.

RESULTS: In the combination group, the median age was 65 years (range, 34-77 years), the median tumor number was 3 (range, 2-9), and the median tumor size was 6 cm (range, 1.2-14 cm). In the resection group, the median age was 51.5 years (range, 27-80 years, P = 0.003), the median tumor number was 3 (range, 2-9, P = 0.574), and the median tumor size was 6 cm (range, 1-14 cm, P = 0.782). The two groups were similar in characteristics of tumors and comorbidities, and had comparable results in preoperative liver function tests. All patients had Child-Pugh class A status. Bilobar involvement occurred in 14 patients (73.6%) in the combination group and 3 patients (5.5%) in the resection group (P = 0.04). Six patients (32%) in the combination group and 35 patients (65%) in the resection group underwent major hepatectomy. Thirteen patients (68%) in the combination group and 19 patients (35%) in the resection group underwent minor hepatectomy (P = 0.012). The combination group had fewer major resections (32% vs 65%, P = 0.012), less blood loss (400 vs 657 mL, P = 0.007), shorter operation time (270 vs 400 min, P = 0.001), and shorter hospital stay (7 vs 8.5 d, P = 0.042). The two groups displayed no major differences in surgical complications (15.8% vs 31.5%, P = 0.24), disease recurrence (63.2% vs 50%, P = 0.673), hospital mortality (5.3% vs 5.6%, P = 1), and overall survival (53 vs 44.5 mo, P = 0.496).

CONCLUSION: Safe and effective for selected patients with multifocal hepatocellular carcinoma, the combination of resection and intraoperative RFA widens the applicability of surgical intervention for the disease.

Keywords: Hepatocellular carcinoma, Radiofrequency ablation, Combined resection, Resection, Cirrhosis