Published online Mar 15, 2019. doi: 10.4251/wjgo.v11.i3.227
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
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.
To compare the long-term therapeutic outcomes of hepatic resection and percutaneous RF ablation for HCCs abutting the diaphragm.
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.
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).
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.