Contrast enhanced intraoperative ultrasonography-guided radiofrequency ablation of recurrent hepatocellular carcinoma after hepatectomy through percutaneous or open approach: a retrospective cohort study

Radiofrequency ablation (RFA) is one of the best alternatives for treatment of recurrent hepatocellular carcinoma through percutaneous or an open approach under the guidance of contrast enhanced intraoperative ultrasonography (CE-IOUS). A total of 89 recurrent cases undergoing PRFA or ORFA under the guidance of CE-IOUS were collected in West China Hospital of Sichuan University from 2005 to 2009. Complete ablation was evaluated by CT 1 month after RFA. Abdominal ultrasonographies and alpha fetoprotein were performed every 3 months to demonstrate recurrent sites during the follow-up period. Cumulative overall survival rates, survival rates after RFA, re-recurrent rates, and complications were analyzed between the two approaches. A total of 119 recurrent tumors of 89 patients were ablated in the two approaches (59.7%, 71/119 tumors in percutaneous group versus 40.3%, 48/119 tumors in open group). Contrast enhanced CT scans demonstrated that all tumors were completely ablated 1 month after RFA during the follow-up period. Complication rate was 7.4% (4/54) in the percutaneous group, compared to 11.4% (4/35) in the open group (p=0.517). The 1-year, 3-year, and 5-year cumulative overall survival rates were 93%, 37%, and 19%, respectively, and 1-year, 2-year, and 3-year survival rates after RFA were 57%, 31%, and 15%, respectively. Moreover, 27.8% of patients (15/54) had re-recurrence in the percutaneous group, compared to 22.9% of patients (8/35) in the open group (p=0.604). No statistically significant differences were observed between the two approaches. CE-IOUS guided RFA is an effective and safe method of treating recurrent hepatic tumors, achieving complete ablation of all tumors in the present study. PRFA and ORFA have advantages and disadvantages, respectively. Appropriate selection of each is dependent on different situations for recurrent tumors.