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A

Prospec*ve Randomized Trial Comparing


Percutaneous Local Abla*ve Therapy and Par*al
Hepatectomy for Small Hepatocellular Carcinoma
RFS Journal Primer

Quick Summary
BOTTOM LINE

A prospective randomized trial on 180 patients with solitary HCC <5cm found percutaneous local
ablative therapy (PLAT) to be as effective as surgical resection.


MAJOR POINTS

The 1-, 2-, 3-, and 4-year overall survival rates and disease-free survival rates were not signiOicantly
different between the PLAT and surgical resection groups.

Surgical resection had more major complications (50/90 patients) vs PLAT (3/71)

Pain: all surgical patients required analgesics. Only 16 patients required analgesics after PLAT.

Longer hospital stay for surgical patients (19.70 vs 9.18 days).

CRITICISM

Post randomization exclusion of 19/90 PLAT patients. Withdrew consent.

Mean follow up of just beyond 2 years.

Relatively small sample size (180 patients)

Study design
SINGLE CENTER PROSPECTIVE RANDOMIZED TRIAL

180 patients: 90 received PLAT, 90 had surgical resection: Nov 1999 June
2004.

INCLUSION CRITERIA

Age 18-75

Solitary HCC < 5cm in diameter

No extrahepatic metastasis or major portal/hepatic vein invasion

Pugh-Child Class A

ICG-R15 < 30%

Patients suitable for either intervention

EXCLUSION CRITERIA

Previous HCC treatment

Platelet count <40,000, history of encephalopathy, ascites refractory to diuretics,


variceal bleeding

Purpose

To compare percutaneous local ablative therapy with surgical resection in the treatment of
solitary and small hepatocellular carcinoma.

http://www.nature.com/modpathol/journal/v27/n3/Oig_tab/modpathol201380f5.html

Interven7on: RFA
Radiofrequency Ablation

RF 2000; Radio-Therapeutics, Mountain View, Ca), needle electrode with 15-gauge insulated
cannula with 10 hook-shape expandable electrode tines with a diameter of 3.5 cm at
expansion.

Local anesthetics, intravenous sedation, or lumbar epidural anesthesia

Start with 10 W of power, increase 10 W/min 90 W

Apply until marked increase in impedance or 15 minutes

Up to 3 applications if necessary

More placement of needles if tumor >3cm or initial unsatisfactory placement

Goal: hyperechoic area covering larger area than HCC.


Follow-up

Dual-phase spiral CT: at 4 weeks post-op every 2 months for Oirst 2years ever 3 months

LFTs, AFPs at each visit. Chest X-ray every 6 months.

If residual viable tumor, additional RFA or PEI.

If still present after repeat treatments, TACE was performed.

Interven7on: Surgical Resec7on

General anesthesia

Right subcostal incision with midline extension

Couinaud liver segment resection:


1 segment resection: 69 patients
2 segment resection: 16 patients
3 or more segments: 3 patients

Goal: resection margin of at least 1 cm

Clamp/unclamp time of 10 min/5 min.

Hemostasis of raw liver surface with suturing and Oibrin glue

Outcome

Intent-to-Treat: 19 PLAT patients withdrew consent; underwent surgical resection

1-, 2-, 3-, and 4-year overall survival rates


PLAT: 94.4%, 79.8%, 68.6%, 65.9%
Resection: 93.3%, 82.3%, 73.4%, 64.0%

1-, 2-, 3-, and 4-year disease-free survival rates


PLAT: 90.8%, 68.6%, 59.8%, 48.2%
Resection: 86.6%, 76.8%, 69.0%, 51.6%

No signiOicant difference after post-randomization exclusion

No statistically signiOicant difference in overall & disease-free survival between the two groups

No statistically signiOicant difference in overall & disease-free survival when analyzing tumors
<3cm and 3.1-5.0 cm.

Surgical resection major complications (50/90 patients): Liver failure, GI bleed, moderate/
severe ascites, persistent jaundice >30 days after surgery.

PLAT major complications (3/71): mild burn at electrode pad sites.

Pain: all surgical patients required analgesics. Only 16 patients required analgesics after PLAT.

Longer hospital stay for surgical patients (19.70 vs 9.18).

Credits

SUMMARY BY:

Harout Dermendjian MS3
Keck School of Medicine
University of Southern California

FULL CITATION:
Chen MS, Li JQ, Zheng Y, et al. A prospective randomized trial comparing percutaneous local ablative therapy and partial
hepatectomy for small hepatocellular carcinoma. Ann Surg. 2006; 243: 321-328.

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