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.
CRITICISM
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
Pugh-Child Class A
EXCLUSION CRITERIA
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.
Up to 3 applications if necessary
Follow-up
Dual-phase spiral CT: at 4 weeks post-op every 2 months for Oirst 2years ever 3 months
General anesthesia
Outcome
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.
Pain: all surgical patients required analgesics. Only 16 patients required analgesics after PLAT.
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.
sirweb.org