Clinical

Percutaneous ablation offers advantages over surgery for small liver cancer

Last Updated: 2006-03-23 13:40:14 -0400 (Reuters Health)

NEW YORK (Reuters Health) - As a treatment for solitary and small hepatocellular carcinoma (HCC), percutaneous local ablative therapy (PLAT) is just as effective as partial hepatectomy, but is associated with less postoperative pain and a much shorter hospital stay, new research shows.

With PLAT, a needle electrode is used to deliver ablative radiofrequencies to the tumor bed. The procedure is typically done using local anesthetics combined with intravenous sedation or epidural anesthesia. The present study is the first randomized prospective trial to compare PLAT as a treatment for small HCC with partial hepatectomy, the current gold standard.

The findings, which appear in the Annals of Surgery for March, are based on a study of 180 patients who were randomized to undergo PLAT or partial hepatectomy for a solitary HCC of no greater than 5 cm in diameter.

Nineteen of the 90 patients randomized to undergo PLAT withdrew their consent before the procedure was performed. The partial hepatectomies performed included a single Couinaud liver segment resection in 69 patients, 2 segments in 16 patients, and at least 3 segments in 3 patients.

The in-hospital mortality rates for the surgery and PLAT groups were 1.1% and 0%, respectively. Postoperative complications were more common in the surgery group and more severe, the report indicates.

No significant differences were seen between the groups in overall or disease-free survival. At 4 years, the overall and disease-free survival rates in each group hovered around 94% and 86%, respectively.

All patients in the surgery group required analgesics for pain control postoperatively compared with just 16 patients in the PLAT group (p < 0.05). Moreover, the average hospital stay after surgery was 19.7 days, nearly double the 9.18-day stay seen after PLAT (p < 0.05).

The results suggest that PLAT does not compromise survival outcomes and "has the advantage over liver resection in giving better short-term postoperative results because PLAT is a less invasive procedure," the authors conclude.

Ann Surg 2006;243:321-328.