Korean Journal of Radiology

The Korean Society of Radiology (대한영상의학회)
권호 표지
DOI QR코드

DOI QR Code

Laparoscopic Hepatic Resection Versus Laparoscopic Radiofrequency Ablation for Subcapsular Hepatocellular Carcinomas Smaller Than 3 cm: Analysis of Treatment Outcomes Using Propensity Score Matching

  • Seong Eun Ko (Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Min Woo Lee (Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Soohyun Ahn (Department of Mathematics, Ajou University) ;
  • Hyunchul Rhim (Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Tae Wook Kang (Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Kyoung Doo Song (Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Jong Man Kim (Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Gyu-Seong Choi (Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Dong Ik Cha (Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Ji Hye Min (Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Dong Hyun Sinn (Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Moon Seok Choi (Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Hyo Keun Lim (Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine)
  • Received : 2021.10.14
  • Accepted : 2022.01.04
  • Published : 2022.06.01
Download PDF
⟨ Previous Next ⟩

Abstract

Objective: To compare the therapeutic outcomes of laparoscopic hepatic resection (LHR) and laparoscopic radiofrequency ablation (LRFA) for single subcapsular hepatocellular carcinoma (HCC). Materials and Methods: We screened 244 consecutive patients who had received either LHR or LRFA between January 2014 and December 2016. The feasibility of LRFA in patients who underwent LHR was retrospectively assessed by two interventional radiologists. Finally, 60 LRFA-feasible patients who had received LHR and 29 patients who had received LRFA as the first treatment for a solitary subcapsular HCC between 1 cm and 3 cm were finally included. We compared the therapeutic outcomes, including local tumor progression (LTP), recurrence-free survival (RFS), and overall survival (OS) between the two groups before and after propensity score (PS) matching. Multivariable Cox proportional hazard regression was also used to evaluate the difference in OS and RFS between the two groups for all 89 patients. Results: PS matching yielded 23 patients in each group. The cumulative LTP and OS rates were not significantly different between the LHR and LRFA groups after PS matching (p = 0.900 and 0.003, respectively). The 5-year LTP rates were 4.6% and 4.4%, respectively, and OS rates were 100% and 90.7%, respectively. The RFS rate was higher in LHR group without statistical significance (p = 0.070), with 5-year rates of 78.3% and 45.3%, respectively. OS was not significantly different between the LHR (reference) and LRFA groups in multivariable analyses, with a hazard ratio (HR) of 1.33 (95% confidence interval, 0.12-1.54) (p = 0.818). RFS was higher in LHR (reference) than in LRFA without statistical significance in multivariable analysis, with an HR of 2.01 (0.87-4.66) (p = 0.102). Conclusion: There was no significant difference in therapeutic outcomes between LHR and LRFA for single subcapsular HCCs measuring 1-3 cm. The difference in RFS should be further evaluated in a larger study.

Keywords

References

  1. European Association for the Study of the Liver. EASL clinical practice guidelines: management of hepatocellular carcinoma. J Hepatol 2018;69:182-236 
  2. Marrero JA, Kulik LM, Sirlin CB, Zhu AX, Finn RS, Abecassis MM, et al. Diagnosis, staging, and management of hepatocellular carcinoma: 2018 practice guidance by the American Association for the study of liver diseases. Hepatology 2018;68:723-750 
  3. Kim JE, Kim YS, Rhim H, Lim HK, Lee MW, Choi D, et al. Outcomes of patients with hepatocellular carcinoma referred for percutaneous radiofrequency ablation at a tertiary center: analysis focused on the feasibility with the use of ultrasonography guidance. Eur J Radiol 2011;79:e80-e84 
  4. Lee MW, Kim YJ, Park HS, Yu NC, Jung SI, Ko SY, et al. Targeted sonography for small hepatocellular carcinoma discovered by CT or MRI: factors affecting sonographic detection. AJR Am J Roentgenol 2010;194:W396-W400 
  5. Worakitsitisatorn A, Lu DS, Lee MW, Asvadi NH, Moshksar A, Yuen AD, et al. Percutaneous thermal ablation of subcapsular hepatocellular carcinomas: influence of tumor-surface contact and protrusion on therapeutic efficacy and safety. Eur Radiol 2020;30:1813-1821 
  6. Song KD, Lim HK, Rhim H, Lee MW, Kang TW, Paik YH, et al. Hepatic resection vs percutaneous radiofrequency ablation of hepatocellular carcinoma abutting right diaphragm. World J Gastrointest Oncol 2019;11:227-237 
  7. Lai ZC, Liang JY, Chen LD, Wang Z, Ruan SM, Xie XY, et al. Do hepatocellular carcinomas located in subcapsular space or in proximity to vessels increase the rate of local tumor progression? A meta-analysis. Life Sci 2018;207:381-385 
  8. Santambrogio R, Barabino M, De Nicola E, Galfrascoli E, Giovenzana M, Zappa MA. Laparoscopic ablation therapies for hepatocellular carcinoma: could specific indications for the laparoscopic approach influence the effectiveness? Updates Surg 2020;72:435-443 
  9. de la Serna S, Vilana R, Sanchez-Cabus S, Calatayud D, Ferrer J, Molina V, et al. Results of laparoscopic radiofrequency ablation for HCC. Could the location of the tumour influence a complete response to treatment? A single European centre experience. HPB (Oxford) 2015;17:387-393 
  10. Sakaguchi H, Seki S, Tsuji K, Teramoto K, Suzuki M, Kioka K, et al. Endoscopic thermal ablation therapies for hepatocellular carcinoma: a multi-center study. Hepatol Res 2009;39:47-52 
  11. Ko SE, Lee MW, Min JH, Ahn SH, Rhim H, Kang TW, et al. Laparoscopic radiofrequency ablation of subcapsular hepatocellular carcinomas: risk factors related to a technical failure. Surg Endosc 2022;36:504-514 
  12. Tzanis D, Shivathirthan N, Laurent A, Abu Hilal M, Soubrane O, Kazaryan AM, et al. European experience of laparoscopic major hepatectomy. J Hepatobiliary Pancreat Sci 2013;20:120-124 
  13. Mirnezami R, Mirnezami AH, Chandrakumaran K, Abu Hilal M, Pearce NW, Primrose JN, et al. Short- and long-term outcomes after laparoscopic and open hepatic resection: systematic review and meta-analysis. HPB (Oxford) 2011;13:295-308 
  14. Yazici P, Akyuz M, Yigitbas H, Dural C, Okoh A, Aydin N, et al. A comparison of perioperative outcomes in elderly patients with malignant liver tumors undergoing laparoscopic liver resection versus radiofrequency ablation. Surg Endosc 2017;31:1269-1274 
  15. Casaccia M, Santori G, Bottino G, Diviacco P, Andorno E. Laparoscopic resection vs laparoscopic radiofrequency ablation for the treatment of small hepatocellular carcinomas: a single-center analysis. World J Gastroenterol 2017;23:653-660 
  16. Korean Liver Cancer Study Group, National Cancer Center Korea. 2014 Korean Liver Cancer Study Group-National Cancer Center Korea practice guideline for the management of hepatocellular carcinoma. Korean J Radiol 2015;16:465-522 
  17. Santambrogio R, Bruno S, Kluger MD, Costa M, Salceda J, Belli A, et al. Laparoscopic ablation therapies or hepatic resection in cirrhotic patients with small hepatocellular carcinoma. Dig Liver Dis 2016;48:189-196 
  18. Santambrogio R, Barabino M, Bruno S, Mariani N, Maroni N, Bertolini E, et al. Surgical resection vs. ablative therapies through a laparoscopic approach for hepatocellular carcinoma: a comparative study. J Gastrointest Surg 2018;22:650-660 
  19. Tsukamoto M, Imai K, Yamashita YI, Kitano Y, Okabe H, Nakagawa S, et al. Endoscopic hepatic resection and endoscopic radiofrequency ablation as initial treatments for hepatocellular carcinoma within the Milan criteria. Surg Today 2020;50:402-412 
  20. Morimoto N, Isoda N, Takaoka Y, Hirosawa T, Watanabe S, Otake T, et al. Short-term results of laparoscopic radiofrequency ablation using a multipolar system for localized hepatocellular carcinoma. Liver Cancer 2017;6:137-145 
  21. Shimada S, Kamiyama T, Yokoo H, Orimo T, Wakayama K, Einama T, et al. Clinicopathological characteristics of hepatocellular carcinoma with microscopic portal venous invasion and the role of anatomical liver resection in these cases. World J Surg 2017;41:2087-2094 
  22. Kang TW, Kim JM, Rhim H, Lee MW, Kim YS, Lim HK, et al. Small hepatocellular carcinoma: radiofrequency ablation versus nonanatomic resection-propensity score analyses of long-term outcomes. Radiology 2015;275:908-919