Comparison of repeated surgical resection and radiofrequency ablation for small recurrent hepatocellular carcinoma after primary resection

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// Wei-Chi Sun 1, 2, * , I-Shu Chen 2, 3, * , Huei-Lung Liang 1, 4 , Cheng-Chung Tsai 2, 3 , Yu-Chia Chen 2, 3 , Being-Whey Wang 2, 3 , Huey-Shyan Lin 5 , Hoi-Hung Chan 1, 2 , Ping-I Hsu 1, 2 , Wei-Lun Tsai 1, 2 and Jin-Shiung Cheng 1, 2 1 Division of Gastroenterology and Hepatology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan 2 Shool of Medicine, National Yang-Ming University, Taipei, Taiwan 3 Division of General Surgery, Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan 4 Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan 5 School of Nursing, Fooying University, Kaohsiung, Taiwan * These authors contributed equally to this work Correspondence to: Wei-Lun Tsai, email: tsaiwl@yahoo.com.tw Keywords: hepatocellular carcinoma, radiofrequency ablation, resection Received: April 19, 2017 Accepted: September 20, 2017 Published: October 07, 2017 ABSTRACT There is controversy concerning whether radiofrequency ablation (RFA) or surgical resection (SR) is a better treatment option for recurrent HCC after resection. In Kaohsiung Veteran General Hospital, from January 2002 to September 2014, a total of 100 consecutive patients who developed recurrent HCCs with a tumor size ≦ 3 cm and tumor numbers ≦ 3 after surgical resection were enrolled. Among these patients, 57 patients received RFA and 43 patients underwent repeated SR. Baseline characteristics at the time of recurrence after hepatic resection and clinical outcomes following treatment of recurrent HCC were compared between the two groups. The baseline data of initial HCC and the first recurrence of HCC were comparable in both groups. The 1-, 3-, 5-year overall survival rates following treatment of the first recurrence of HCC were 97.6%, 82.7%, 56.4% in the repeated SR group and 98.2%, 77.2%, 52.6% in the RFA group ( p = 0.69). The 1-, 3-, 5-year disease-free survival rates were 57.0%, 32.1%, 28.6% in the repeated SR group and 60.8%, 26.6%, 16.6% in the RFA group (( p = 0.89). There was a trend whereby patients who underwent repeated SR had more procedure-related morbidity than patients who underwent RFA (16% vs. 7%, p = 0.14). The median total hospital days were longer in the repeated SR group than that in the RFA group (13 vs. 5 days, p < 0.05). In the small recurrent HCCs after SR, RFA achieved similar overall survival and disease-free survival than those with repeated SR as well as having a shorter hospital stay.