| BACKGROUND:Although Surgical resection is the preferred treatment for patients with hepatocellular carcinoma,the long-term prognosis remains unsatisfactory due to the high recurrence rate after surgery,therefore,the selection of an effective treatment strategy is crucial to prolong the long-term survival of patients with recurrent hepatocellular carcinoma.Surgical re-resection and radiofrequency ablation(RFA)are currently commonly used in the treatment of recurrent hepatocellular carcinoma(RHCC),and the clinical efficacy remains controversial.PURPOSE:The aim of this Meta-analysis was to evaluate the efficacy and safety of Surgical re-resection versus radiofrequency ablation for the treatment of recurrent hepatocellular carcinoma meeting the Milan criteria.METHODS:A computer search of foreign language databases such as Pub Med,Medline,Embase,Web of Science and Cochrane library and Chinese databases such as CNKI,Wanfang,Sino Med and Wipu was conducted to retrieve comparative studies on surgical re-resection and radiofrequency ablation for recurrent hepatocellular carcinoma,and the literature was strictly selected according to the inclusion and exclusion criteria.We used the Cochrane Risk Bias Assessment Tool and the NOS scale to evaluate the quality of the included studies.We used the Cochrane Collaboration’s Rev Man 5.4 software and the State17 software developed by State corp to perform statistical analyses,and the Q test and I~2test to test the heterogeneity of the included studies,Random effects models or fixed effects models were used to combine the effect sizes for each outcome based on the results of the heterogeneity test and calculated for 95%Confidence Interval(95%CL).RESULTS:17 studies were eventually included,5 randomised controlled trials and 12cohort studies,involving a total of 2473 patients with recurrent hepatocellular carcinoma,including 1252 in the re-surgical group and 1221 in the radiofrequency ablation group.The results of meta-analysis showed that there was no statistically significant difference in overall survival in the re-surgical group compared with the radiofrequency ablation group(HR=0.92,95%Cl:0.80-1.05,P=0.20),However,the disease-free survival was significantly better in the re-surgical group than in the radiofrequency ablation group(HR=0.76,95%Cl:0.66-0.87,P<0.001).In terms of postoperative safety,the overall postoperative complication rate was significantly lower in the radiofrequency ablation group than in the re-surgical group(OR=4.88,95%Cl:3.62-6.58,P<0.001),while the postoperative hospital stay was shorter in the radiofrequency ablation group(MD=7.03,95%Cl:5.96-8.09,P<0.001).CONCLUSION:1、For patients with recurrent hepatocellular carcinoma within the Milan criteria,radiofrequency ablation was able to achieve similar overall survival as re-surgical resection,but re-surgical resection is better at reducing the risk of recurrence after surgery than radiofrequency ablation.2、radiofrequency ablation was superior to re-surgical resection in terms of length of hospital stay and treatment-related complication rates,it has better security.3、radiofrequency ablation may be considered as an alternative treatment for patients with recurrent hepatocellular carcinoma within the Milan criteria. |
