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World J Gastroenterol. Jul 14, 2013; 19(26): 4106-4118
Published online Jul 14, 2013. doi: 10.3748/wjg.v19.i26.4106
Systematic review of surgical resection vs radiofrequency ablation for hepatocellular carcinoma
Alessandro Cucchetti, Fabio Piscaglia, Matteo Cescon, Giorgio Ercolani, Antonio Daniele Pinna
Alessandro Cucchetti, Matteo Cescon, Giorgio Ercolani, Antonio Daniele Pinna, General Surgery and Transplant Unit, Department of General Surgery and Organ Transplantation, Alma Mater Studiorum-University of Bologna, 40138 Bologna, Italy
Alessandro Cucchetti, Policlinico Sant’Orsola-Malpighi, University of Bologna, 40138 Bologna, Italy
Fabio Piscaglia, Division of Internal Medicine, Department of Clinical Medicine, S Orsola-Malpighi Hospital, Alma Mater Studiorum-University of Bologna, 40138 Bologna, Italy
Author contributions: Cucchetti A, Ercolani G and Cescon M performed the literature search and wrote the paper; Piscaglia F provided critical expertise and reviewed the paper; Pinna AD provided critical expertise and helped with focusing the topics.
Supported by A speaker fee from Siemens, research contracts with Esaote; and advisory board and speaker fee from Bayer to Fabio Piscaglia
Correspondence to: Alessandro Cucchetti, MD, Policlinico Sant’Orsola-Malpighi, University of Bologna, Via Massarenti, 9, 40138 Bologna, Italy.
Telephone: +39-51-6363721 Fax: +39-51-304902
Received: March 26, 2013
Revised: April 26, 2013
Accepted: June 18, 2013
Published online: July 14, 2013

Hepatocellular carcinoma (HCC) represents one of the most common neoplasms worldwide. Surgical resection and local ablative therapies represent the most frequent first lines therapies adopted when liver transplantation can not be offered or is not immediately accessible. Hepatic resection (HR) is currently considered the most curative strategy, but in the last decade local ablative therapies have started to obtain satisfactory results in term of efficacy and, of them, radiofrequency ablation (RFA) is considered the reference standard. An extensive literature review, from the year 2000, was performed, focusing on results coming from studies that directly compared HR and RFA. Qualities of the studies, characteristics of patients included, and patient survival and recurrence rates were analyzed. Except for three randomized controlled trials (RCT), most studies are affected by uncertain methodological approaches since surgical and ablated patients represent different populations as regards clinical and tumor features that are known to affect prognosis. Unfortunately, even the available RCTs report conflicting results. Until further evidences become available, it seems reasonable to offer RFA to very small HCC (< 2 cm) with no technical contraindications, since in this instance complete necrosis is most likely to be achieved. In larger nodules, namely > 2 cm and especially if > 3 cm, and/or in tumor locations in which ablation is not expected to be effective or safe, surgical removal is to be preferred.

Keywords: Hepatocellular carcinoma, Hepatic resection, Surgical therapy, Ablation techniques, Survival, Liver failure

Core tip: The present review shows the lights and shadows of the comparative literature regarding hepatic resection and radiofrequency ablation for hepatocellular carcinoma. Nineteen studies that directly compared these two therapies were found through an extensive literature review; of them, three randomized controlled trial were available for comparison whereas the remaining studies were represented by retrospective observational studies. Results are often conflicting and further randomized controlled trial are warranted; otherwise, retrospective observational studies should include in their analyses statistical approaches aimed at reduce possible confounding sources at a minimum.