Abstract

BACKGROUND:There is no definite agreement on the bettertherapy (radiofrequency ablation (RFA) versus surgical resection (SR)) forearly hepatocellular carcinoma (HCC) eligible for surgical treatments. Thepurpose of this study is to evaluate the evidence using meta-analyticaltechniques.

METHODS:A literature search was undertaken until December2011 to identify comparative studies evaluating survival rates, recurrencerates, and complications. Pooled odds ratios (OR) and 95% confidence intervals(95% CI) were calculated with either the fixed or random effect model.

RESULTS:Thirteen articles, comprising two randomizedcontrolled trials(RCTs), were included in the review, with a total of 2,535patients (1,233 treated with SR and 1,302 with RFA). The overall survival rateswere significantly higher in patients treated with SR than RFA after1, 3, and 5 years (respectively: OR,0.60 (95% CI, 0.42 to 0.86); OR, 0.49 (95% CI, 0.36 to 0.65); OR, 0.60 (95% CI,0.43 to 0.84)). In the SR group, the 1, 3, and 5 years recurrence rates were significantlylower than the RFA group (respectively: OR, 1.48 (95% CI, 1.05 to 2.08); OR,1.76 (95% CI, 1.49 to 2.08); OR, 1.68 (95% CI, 1.21 to 2.34)). However, localrecurrence between two groups did not exhibit significant difference. For HCC ≤ 3 cm in diameter, SR wasbetter than RFA at the 1, 3, and 5 years overall survival rates (respectively: OR, 0.34 (95% CI, 0.13to 0.89); OR, 0.56 (95% CI, 0.37 to 0.84); OR, 0.44 (95% CI, 0.31 to 0.62)).This meta-analysis indicated that the complication of SR was higher than RFA(OR, 6.25 (95%CI, 3.12 to 12.52); P = 0.000).

CONCLUSION:Although local recurrence between two groups didnot exhibit significant difference, SR demonstrated significantly improvedsurvival benefits and lower complications for patients with early HCC,especially for HCC ≤ 3 cm in diameter. Thesefindings should be interpreted carefully, owing to the lower level of evidence.