Skip to main content Accessibility help
×
Home
Hostname: page-component-65dc7cd545-9glht Total loading time: 0.242 Render date: 2021-07-25T15:50:48.840Z Has data issue: true Feature Flags: { "shouldUseShareProductTool": true, "shouldUseHypothesis": true, "isUnsiloEnabled": true, "metricsAbstractViews": false, "figures": true, "newCiteModal": false, "newCitedByModal": true, "newEcommerce": true, "newUsageEvents": true }

Percutaneous radiofrequency ablation for the treatment of early stage hepatocellular carcinoma: A health technology assessment

Published online by Cambridge University Press:  06 October 2010

Xuanqian Xie
Affiliation:
McGill University Health Centre
Nandini Dendukuri
Affiliation:
McGill University and McGill University Health Centre
Maurice McGregor
Affiliation:
McGill University and McGill University Health Centre

Abstract

Objectives: The aim of this study was to compare the clinical effectiveness and cost of percutaneous radiofrequency ablation (PRFA) and surgical resection (SRS) for the management of early stage Hepatocellular Carcinoma.

Methods: A systematic literature search of articles in English, French, and Chinese was performed using online databases. Only articles with patients classified as Child-Pugh Class A or B, with tumor size <5 cm were included. A meta-analysis was carried out to estimate the survival rate and disease-free survival rate following PRFA or SRS treatments. The cost of each treatment was estimated from the third party perspective. Univariate sensitivity analyses were used to study the relative importance of each component cost.

Results: We identified six studies (one randomized controlled trial (RCT) and five comparative cohort studies) meeting our inclusion criteria. There is good evidence that among Child-Pugh A patients for whom both SRS and PRFA are available options, survival rates following either procedure are comparable, while complications are more frequent and hospitalization longer following SRS. The evidence concerning recurrence rates and disease-free survival is less clear. Whereas the RCT indicates comparable outcomes with either procedure up to 3 years, the results of five cohort studies (with possible selection bias), particularly those with a mix of Child-Pugh A and B patients, favor the surgical option. SRS, costs approximately Canadian $8,275 more per case than PRFA.

Conclusions: Continuing doubts on this issue can only be resolved by a substantial RCT. Meanwhile, for early stage HCC patients classified as Child-Pugh A, who despite a possibly higher recurrence rate, prefer the less invasive PRFA to open surgery with its attendant risks, there is sufficient evidence to justify such a choice. For those classified as Child-Pugh (B) it is possible that overall survival is equally good with PRFA, but the evidence is less certain.

Type
ASSESSMENTS
Copyright
Copyright © Cambridge University Press 2010

Access options

Get access to the full version of this content by using one of the access options below.

References

1. Amersi, FF, Elrath-Garza, A, Ahmad, A, et al. Long-term survival after radiofrequency ablation of complex unresectable liver tumors. Arch Surg. 2006;141:581587.CrossRefGoogle ScholarPubMed
2. Bouza, AC, Martin, FJ, Magro, PMA, et al. Efficacy and safety of radiofrequency ablation of malignant liver tumours: A systematic review. Madrid: Agencia de Evaluacion de Tecnologias Sanitarias (AETS); 2004.Google Scholar
3. Buell, JF, Thomas, MT, Rudich, S, et al. Experience with more than 500 minimally invasive hepatic procedures. Ann Surg. 2008;248:475486.Google ScholarPubMed
4. Chen, MS, Li, JQ, Liang, HH, et al. [Comparison of effects of percutaneous radiofrequency ablation and surgical resection on small hepatocellular carcinoma]. Zhonghua Yi Xue Za Zhi. 2005;85:8083.Google Scholar
5. Chen, MS, Li, JQ, Zheng, Y, et al. A prospective randomized trial comparing percutaneous local ablative therapy and partial hepatectomy for small hepatocellular carcinoma. Ann Surg. 2006;243:321328.CrossRefGoogle ScholarPubMed
6. Chen, RF, Xiao, TH, Zhou, QB. [Therapeutic clinical effect of radiofrequency ablation for small hepatocellular carcinoma in cirrhotic patients: A meta-analysis]. Zhonghua Wai Ke Za Zhi. 2008;46:14131418.Google Scholar
7. Cho, CM, Tak, WY, Kweon, YO, et al. [The comparative results of radiofrequency ablation versus surgical resection for the treatment of hepatocellular carcinoma]. Korean J Hepatol. 2005;11:5971.Google Scholar
8. Cormier, JN, Thomas, KT, Chari, RS, Pinson, CW. Management of hepatocellular carcinoma. J Gastrointest Surg. 2006;10:761780.CrossRefGoogle ScholarPubMed
9. Garrean, S, Hering, J, Saied, A, Helton, WS, Espat, NJ. Radiofrequency ablation of primary and metastatic liver tumors: A critical review of the literature. Am J Surg. 2008;195:508520.CrossRefGoogle ScholarPubMed
10. Guglielmi, A, Ruzzenente, A, Valdegamberi, A, et al. Radiofrequency ablation versus surgical resection for the treatment of hepatocellular carcinoma in cirrhosis. J Gastrointest Surg. 2008;12:192198.CrossRefGoogle Scholar
11. Hamza, TH, van Houwelingen, HC, Stijnen, T. The binomial distribution of meta-analysis was preferred to model within-study variability. J Clin Epidemiol. 2008;61:4151.CrossRefGoogle ScholarPubMed
12. Hasegawa, K, Makuuchi, M, Takayama, T, et al. Surgical resection vs. percutaneous ablation for hepatocellular carcinoma: A preliminary report of the Japanese nationwide survey. J Hepatol. 2008;49:589594.CrossRefGoogle ScholarPubMed
13. Hong, SN, Lee, SY, Choi, MS, et al. Comparing the outcomes of radiofrequency ablation and surgery in patients with a single small hepatocellular carcinoma and well-preserved hepatic function. J Clin Gastroenterol. 2005;39:247252.CrossRefGoogle Scholar
14. Khan, MR, Poon, RT, Ng, KK, et al. Comparison of percutaneous and surgical approaches for radiofrequency ablation of small and medium hepatocellular carcinoma. Arch Surg. 2007;142:11361143.CrossRefGoogle Scholar
15. Kooby, DA, Egnatashvili, V, Graiser, M, et al. Changing management and outcome of hepatocellular carcinoma: Evaluation of 501 patients treated at a single comprehensive center. J Surg Oncol. 2008;98:8188.CrossRefGoogle Scholar
16. Lau, WY, Lai, EC. The current role of radiofrequency ablation in the management of hepatocellular carcinoma: A systematic review. Ann Surg. 2009;249:2025.CrossRefGoogle ScholarPubMed
17. Lencioni, R, Crocetti, L. Radiofrequency ablation of liver cancer. Tech Vasc Interv Radiol. 2007;10:3846.CrossRefGoogle ScholarPubMed
18. Lupo, L, Panzera, P, Giannelli, G, Memeo, M, Gentile, A, Memeo, V. Single hepatocellular carcinoma ranging from 3 to 5 cm: Radiofrequency ablation or resection? HPB. (Oxford). 2007;9:429434.CrossRefGoogle ScholarPubMed
19. Marlow, N E, et al. Radiofrequency ablation for the treatment of liver tumours: A systematic review. ASERNIP-S Report No: 56. Adelaide, South Australia: ASERNIP-S; 2006.Google Scholar
20. National Institute for Clinical Excellence. Radiofrequency ablation for the treatment of colorectal metastases in the liver. London: National Institute for Clinical Excellence (NICE); 2004.Google ScholarPubMed
21. Pugh, RN, Murray-Lyon, IM, Dawson, JL, Pietroni, MC, Williams, R. Transection of the oesophagus for bleeding oesophageal varices. Br J Surg. 1973;60:646649.CrossRefGoogle ScholarPubMed
22. Sutherland, LM, Williams, JA, Padbury, RT, Gotley, DC, Stokes, B, Maddern, GJ. Radiofrequency ablation of liver tumors: A systematic review. Arch Surg. 2006;141:181190.CrossRefGoogle ScholarPubMed
23. Takahashi, S, Kudo, M, Chung, H, et al. Outcomes of nontransplant potentially curative therapy for early-stage hepatocellular carcinoma in Child-Pugh stage A cirrhosis is comparable with liver transplantation. Dig Dis. 2007;25:303309.CrossRefGoogle Scholar
24. Zhai, B, Xu, AM, Chen, Y, Li, XY, Liu, S, Wu, MC. [Radiofrequency ablation for larger hepatocellular carcinomas]. Di Er Jun Yi Da Xue Xue Bao. 2007;28:651655.Google Scholar
Supplementary material: File

Xie et al. supplementary material

Supplementary table

Download Xie et al. supplementary material(File)
File 96 KB
8
Cited by

Send article to Kindle

To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Percutaneous radiofrequency ablation for the treatment of early stage hepatocellular carcinoma: A health technology assessment
Available formats
×

Send article to Dropbox

To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

Percutaneous radiofrequency ablation for the treatment of early stage hepatocellular carcinoma: A health technology assessment
Available formats
×

Send article to Google Drive

To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

Percutaneous radiofrequency ablation for the treatment of early stage hepatocellular carcinoma: A health technology assessment
Available formats
×
×

Reply to: Submit a response

Please enter your response.

Your details

Please enter a valid email address.

Conflicting interests

Do you have any conflicting interests? *