Clinical

Percutaneous radiofrequency ablation effective for small liver tumors

Last Updated: 2008-01-03 15:40:41 -0400 (Reuters Health)

NEW YORK (Reuters Health) - Radiofrequency ablation (RFA) of small hepatocellular carcinoma (HCC) is as effective when delivered percutaneously as with a surgical approach, but with lower morbidity, according to a report in the December issue of the Archives of Surgery.

However, surgical RFA may be preferable for larger tumors.

RFA has been shown to be 85% to 95% effective in ablating HCC 3 cm or less in diameter, the authors explain, but it remains unclear whether the percutaneous or surgical approach should be favored.

Dr. Muhammad Rizwan Khan and colleagues from The University of Hong Kong, Pokfulam, compared the outcome of RFA with the percutaneous approach or the surgical approach in 155 patients with small HCC (3 cm or less) and 73 patients with medium HCC (3.1-5 cm).

For patients with small HCC, postprocedural hepatic function was significantly worse, postoperative complications were more common, intensive care admission was higher, and overall hospital stay was longer in the surgical group, the authors report.

For patients with medium HCC, though, hepatic function, intensive care admission, and complications after RFA were comparable in the two groups. Overall hospital stay was longer in the surgical group.

Complete tumor ablation was achieved in 95% of patients with small HCC in both the percutaneous and surgical groups, the report indicates, and there was no significant difference in the development of recurrence after a mean follow-up of 19 months (36% and 41%, respectively).

Similarly, the complete tumor ablation rates of medium HCC were comparable among patients treated with percutaneous RFA (95%) and surgical RFA (92%), but there was an insignificant trend to higher recurrence rates and distant metastases with percutaneous RFA.

One-year and 3-year overall and disease-free survival rates did not differ between the two groups of patients with small HCC, the investigators say, but both survival rates were worse for patients with medium HCC treated with percutaneous RFA than for those treated with surgical RFA.

"Our study suggests that the percutaneous route is the preferred approach for RFA for small HCC," the authors conclude. "For medium HCC, the surgical approach seems to achieve better tumor control and overall survival and may be the preferred approach if the patient can safely tolerate the procedure."

Arch Surg 2007;142:1136-1143.