Surgery, Ablation: Similar Outcomes for Small Liver Cancers

SAN FRANCISCO – Radiofrequency ablation appears to work as well as surgical resection for treating early-stage hepatocellular carcinomas, based on a randomized trial of 168 patients.

Researchers at Southwest Hospital in Chongqing, China, compared radiofrequency ablation (RFA) with surgical resection; there were 84 patients in each group. Each patient had either one or two tumors that were less than 4 cm in diameter.

In the surgical resection group, 81 patients (96%) were alive at 1 year, 74 (88%) at 2 years, and 63 (75%) at 3 years. In the RFA group, 78 (93%) were alive at 1 year, 70 (83%) at 2 years, and 57 (68%) at 3 years. The differences between groups were not statistically significant (P = .3).

Results for tumor recurrence were similar: 27 (32%) of the surgery patients had tumor recurrence within 3 years, compared with 35 (42%) of the RFA patients. Again, this difference was not statistically significant.

For treatment of one or two liver tumors less than 4 cm, "RFA provided the same overall and recurrence-free survival rates as surgical resection [and] has the advantages of minimal invasiveness and a low occurrence of complications," said lead investigator Dr. Ma Kuansheng of the hospital’s hepatobiliary surgery department. Also, costs are lower with RFA, he added.

The study findings could help settle the debate about which technique is better for treating early liver cancer. "There are always arguments [about whether] you should just cut it out, [or] try [RFA]. I think this study basically shows that there is no difference, so you should decide what’s the most economic way of dealing with this," said Dr. Jake Liang, president of the American Association for the Study of Liver Diseases, at the association’s annual meeting.

In the United States, both treatment approaches are available. However, surgery can be especially difficult in patients with cirrhosis. "Because their livers are all scarred, it’s very difficult to resect them," said Dr. Liang, also chief of the Liver Diseases Branch of the National Institute of Diabetes and Digestive and Kidney Diseases.

Almost 10% of the RFA patients developed complications during the procedure, including two patients with hemorrhage. In contrast, complications occurred in over 20% of surgery patients, including two with hemorrhage that required emergency laparotomy, and one with a liver abscess.

RFA took an average of 41 minutes, and had a mean blood loss of 21 mL. Surgery took 141 minutes on average, and blood loss was a mean of 375 mL; many patients needed transfusions. Length of hospital stay was about 1 week for RFA patients vs. just over 2 weeks for surgery patients.

Eight RFA patients had residual tumor that was missed during the procedure: six with tumor under the liver capsule, one with tumor next to the gallbladder, and one with tumor adjacent to the portal vein trunk. Analysis both with and without those patients did not significantly affect 3-year survival outcomes.

Most of the patients in both arms were men, with a mean age of about 50 years. A total of 85% had blood markers of hepatitis, most often hepatitis B surface antigen. There were no statistically significant baseline differences in alanine aminotransferase; alpha-fetoprotein; tumor size, number, or grade; or other characteristics.

The findings come at a time when liver cancer is on the rise, "mostly because of viral hepatitis," Dr. Liang noted. "The best treatment for liver cancer is liver transplantation. You get a very high cure rate if you transplant early enough, but, obviously, not everybody can be transplanted. There are resource issues," he said.

Dr. Kuansheng and Dr. Liang said they have no financial disclosures.

SAN FRANCISCO – Radiofrequency ablation appears to work as well as surgical resection for treating early-stage hepatocellular carcinomas, based on a randomized trial of 168 patients.

Researchers at Southwest Hospital in Chongqing, China, compared radiofrequency ablation (RFA) with surgical resection; there were 84 patients in each group. Each patient had either one or two tumors that were less than 4 cm in diameter.

In the surgical resection group, 81 patients (96%) were alive at 1 year, 74 (88%) at 2 years, and 63 (75%) at 3 years. In the RFA group, 78 (93%) were alive at 1 year, 70 (83%) at 2 years, and 57 (68%) at 3 years. The differences between groups were not statistically significant (P = .3).

Results for tumor recurrence were similar: 27 (32%) of the surgery patients had tumor recurrence within 3 years, compared with 35 (42%) of the RFA patients. Again, this difference was not statistically significant.

For treatment of one or two liver tumors less than 4 cm, "RFA provided the same overall and recurrence-free survival rates as surgical resection [and] has the advantages of minimal invasiveness and a low occurrence of complications," said lead investigator Dr. Ma Kuansheng of the hospital’s hepatobiliary surgery department. Also, costs are lower with RFA, he added.

The study findings could help settle the debate about which technique is better for treating early liver cancer. "There are always arguments [about whether] you should just cut it out, [or] try [RFA]. I think this study basically shows that there is no difference, so you should decide what’s the most economic way of dealing with this," said Dr. Jake Liang, president of the American Association for the Study of Liver Diseases, at the association’s annual meeting.

In the United States, both treatment approaches are available. However, surgery can be especially difficult in patients with cirrhosis. "Because their livers are all scarred, it’s very difficult to resect them," said Dr. Liang, also chief of the Liver Diseases Branch of the National Institute of Diabetes and Digestive and Kidney Diseases.

Almost 10% of the RFA patients developed complications during the procedure, including two patients with hemorrhage. In contrast, complications occurred in over 20% of surgery patients, including two with hemorrhage that required emergency laparotomy, and one with a liver abscess.

RFA took an average of 41 minutes, and had a mean blood loss of 21 mL. Surgery took 141 minutes on average, and blood loss was a mean of 375 mL; many patients needed transfusions. Length of hospital stay was about 1 week for RFA patients vs. just over 2 weeks for surgery patients.

Eight RFA patients had residual tumor that was missed during the procedure: six with tumor under the liver capsule, one with tumor next to the gallbladder, and one with tumor adjacent to the portal vein trunk. Analysis both with and without those patients did not significantly affect 3-year survival outcomes.

Most of the patients in both arms were men, with a mean age of about 50 years. A total of 85% had blood markers of hepatitis, most often hepatitis B surface antigen. There were no statistically significant baseline differences in alanine aminotransferase; alpha-fetoprotein; tumor size, number, or grade; or other characteristics.

The findings come at a time when liver cancer is on the rise, "mostly because of viral hepatitis," Dr. Liang noted. "The best treatment for liver cancer is liver transplantation. You get a very high cure rate if you transplant early enough, but, obviously, not everybody can be transplanted. There are resource issues," he said.

Dr. Kuansheng and Dr. Liang said they have no financial disclosures.

SAN FRANCISCO – Radiofrequency ablation appears to work as well as surgical resection for treating early-stage hepatocellular carcinomas, based on a randomized trial of 168 patients.

Researchers at Southwest Hospital in Chongqing, China, compared radiofrequency ablation (RFA) with surgical resection; there were 84 patients in each group. Each patient had either one or two tumors that were less than 4 cm in diameter.

In the surgical resection group, 81 patients (96%) were alive at 1 year, 74 (88%) at 2 years, and 63 (75%) at 3 years. In the RFA group, 78 (93%) were alive at 1 year, 70 (83%) at 2 years, and 57 (68%) at 3 years. The differences between groups were not statistically significant (P = .3).

Results for tumor recurrence were similar: 27 (32%) of the surgery patients had tumor recurrence within 3 years, compared with 35 (42%) of the RFA patients. Again, this difference was not statistically significant.

For treatment of one or two liver tumors less than 4 cm, "RFA provided the same overall and recurrence-free survival rates as surgical resection [and] has the advantages of minimal invasiveness and a low occurrence of complications," said lead investigator Dr. Ma Kuansheng of the hospital’s hepatobiliary surgery department. Also, costs are lower with RFA, he added.

The study findings could help settle the debate about which technique is better for treating early liver cancer. "There are always arguments [about whether] you should just cut it out, [or] try [RFA]. I think this study basically shows that there is no difference, so you should decide what’s the most economic way of dealing with this," said Dr. Jake Liang, president of the American Association for the Study of Liver Diseases, at the association’s annual meeting.

In the United States, both treatment approaches are available. However, surgery can be especially difficult in patients with cirrhosis. "Because their livers are all scarred, it’s very difficult to resect them," said Dr. Liang, also chief of the Liver Diseases Branch of the National Institute of Diabetes and Digestive and Kidney Diseases.

Almost 10% of the RFA patients developed complications during the procedure, including two patients with hemorrhage. In contrast, complications occurred in over 20% of surgery patients, including two with hemorrhage that required emergency laparotomy, and one with a liver abscess.

RFA took an average of 41 minutes, and had a mean blood loss of 21 mL. Surgery took 141 minutes on average, and blood loss was a mean of 375 mL; many patients needed transfusions. Length of hospital stay was about 1 week for RFA patients vs. just over 2 weeks for surgery patients.

Eight RFA patients had residual tumor that was missed during the procedure: six with tumor under the liver capsule, one with tumor next to the gallbladder, and one with tumor adjacent to the portal vein trunk. Analysis both with and without those patients did not significantly affect 3-year survival outcomes.

Most of the patients in both arms were men, with a mean age of about 50 years. A total of 85% had blood markers of hepatitis, most often hepatitis B surface antigen. There were no statistically significant baseline differences in alanine aminotransferase; alpha-fetoprotein; tumor size, number, or grade; or other characteristics.

The findings come at a time when liver cancer is on the rise, "mostly because of viral hepatitis," Dr. Liang noted. "The best treatment for liver cancer is liver transplantation. You get a very high cure rate if you transplant early enough, but, obviously, not everybody can be transplanted. There are resource issues," he said.

Dr. Kuansheng and Dr. Liang said they have no financial disclosures.