Radiofrequency ablation versus surgical resection for intrahepatic hepatocellular carcinoma recurrence: a meta-analysis

Background: To compare the clinical efficacy and safety of radiofrequency ablation (RFA) versus surgical resection (SR) for intrahepatic hepatocellular carcinoma (HCC) recurrence by meta-analytical techniques.

Methods: Literature documenting a comparison of RFA and SR for intrahepatic HCC recurrence was identified by searching PubMed, Embase, Cochrane Library, and Web of Science databases, for those from inception to July 2014 with no limits. The heterogeneity was tested by the Cochrane Q statistic; the pooled estimates were measured using either fixed or random effect model. Furthermore, subgroup and sensitivity analyses were conducted to explore heterogeneity between studies and to assess the efficacy of different studies.

Results: Seven studies were included with a total of 718 patients (359 treated with RFA and 359 treated with SR). Our meta-analysis showed that the 1-, 3-, and 5-y overall survival rate and procedure-related mortality rate were similar in patients treated with RFA or SR. Meanwhile, SR was associated with significantly higher 1-, 3-, and 5-y re-recurrence-free survival rate and procedure-related morbidity rate compared with RFA. In the subgroup analysis of patients in China, the results concerning overall and re-recurrence-free survival were similar to the outcomes of the meta-analysis without regional restriction. In the subgroup analysis of intrahepatic recurrent HCC ≤3 cm, the 1-, 3-, and 5-y overall survival rate did not differ significantly in the comparison of RFA and SR.

Conclusions: Although RFA was associated with lower re-recurrence-free survival, it seems to be as effective as SR for the treatment of intrahepatic HCC recurrence owing to comparable overall survival benefits. The advantages of being less invasive, highly target-selective, and repeatable may render RFA a preferred treatment option for selected patients.