A Systematic Review Of Radiofrequency Ablation Versus Hepatic Resection For Patients With Hepatocellular Carcinoma Meeting Milan Criteria

Objective: Radiofrequency ablation (RFA) challenged the primarystatus of hepatic resection (RES) for treating small HCC. Therefore, thissystematic review was aimed to compare the efficacy and safety of RFA withRES in the treatment of patients with small hepatocellular carcinoma (HCC)meeting Milan criteria.Methods: We conducted a search for published articles in Pubmed,Embase and the Cochrane library until January2013. Only clinicalcontrolled trials (CCTs) compared RFA with RES and trials with thecomparability between the two groups concerning tumor size, number,Child-Pugh class and age were included.Results: A total of11CCTs (including3randomized controlled trials)with1413cases were included. Meta-analyses demonstrated that RESsignificantly improved the survival (RFA vs. RES, harzard ratio [HR]:1.39,95%confidence interval [CI]:1.13,1.71, P=0.002) and recurrence-freesurvival (HR:1.65,95%CI:1.37,1.98, P <0.001) of patients with small HCC relative to RFA. During the peri-operative periods, although RFAassociated with less major complications compared with RES (HR:0.30,95%CI:0.19,0.47, P <0.001), the treatment-related mortality discrepancybetween both groups was not significantly (HR:0.51,95%CI:0.13,2.08, P=0.350).Subgroup analyses indicated that RES is superior to RFA withrespect to survival and recurrence-free survival regardless of the subgroup ofCCTs (P <0.001, P=0.016) or RCTs (P=0.002, P=0.046), patientslocated in Europe (P <0.001, P=0.004) or Asia (P=0.001, P=0.034),single (P=0.001, P=0.004) or multiple (P <0.001, P <0.001) nodules.Conclusions: RES is superior to RFA in the treatment of patients withsmall HCC conforming to Milan criteria. However, RCTs are still needed toevaluate the efficacy of RFA vs. RES for HCC patients with nodule <2cm.