Efficacy of re-resection versus radiofrequency ablation for recurrent Barcelona Clinic Liver Cancer stage 0/A hepatocellular carcinoma (HCC) after resection for primary HCC

Background: Whether repeat surgical resection (RSR) or radiofrequency ablation (RFA) is a better option for recurrent hepatocellular carcinoma (HCC) after resection for primary HCC remains controversial. This study was to investigate the clinical efficacy of RSR versus RFA in the treatment of recurrent HCC at Barcelona Clinic Liver Cancer (BCLC) stage 0/A after resection of primary HCC. Methods: The patients treated by RSR (n=57) or RFA (n=51) for recurrent BCLC stage 0/A HCC in the Affiliated Hospital of Nantong University and Third Affiliated Hospital of Second Military Medical University from January 2008 to March 2018 were included. The general condition, clinicopathological characteristics, and survival were analyzed, and the baseline features and long-term survival were compared between two groups. Results: The baseline characteristics were comparable between two groups. The 1-, 3-, and 5-year survival rates were 96.5%, 80.9%, and 60.6% in RSR group, respectively, and 96.1%, 76.8%, and 59.4% in RFA group, respectively (P=0.48). The 1-, 3-, and 5-year overall survival (OS) rates after treatment for recurrent HCC were 78.9%, 50.5%, and 29.7% in RSR group, respectively, and 80.3%, 50.9%, and 26.0% in RFA group, respectively (P=0.67). The 1-, 3-, and 5-year disease-free survival rates were 68.4%, 39.4%, and 26.6% in RSR group, respectively, and 62.8%, 32.8%, and 20.4% in RFA group, respectively (P=0.55). The incidence of treatment-related complications was significantly higher in the RSR than in the RFA group (42.11% vs. 11.76%, P< 0.001). The median hospital stay was significantly shorter in the RFA than in the RSR group (3 vs. 9 days, P< 0.001). Conclusions: RSR and RFA have similar survival benefits in the treatment of recurrent BCLC stage 0/A HCC. RFA is superior to RSR in terms of hospital stay and incidence of treatment-related complications.