Radiofrequency Ablation Versus Hepatic Resection for Small Hepatocellular Carcinoma A Meta- analysis of Randomized Controlled Trials

Background and Goals:Whether radiofrequency ablation or hepatic resection is superior for improving the survival in patients with small hepatocellular carcinoma (HCC) remains controversial. A meta-analysis of randomized controlled trials was performed to examine this issue.Methods:PubMed, EMBASE, and Cochrane Library databases were used to identify all randomized controlled trials comparing the survival between small HCC patients receiving radiofrequency ablation and hepatic resection. The hazard ratio (HR) was pooled to compare the overall survival and recurrence-free survival rates. The odds ratio was pooled to compare the incidence of treatment-related complications. The mean difference was pooled to compare the hospitalization duration. Heterogeneity among studies was assessed.Results:Three randomized controlled trials were included in this meta-analysis. All patients met the Milan criteria. Hepatic resection was superior to radiofrequency ablation for the improvement of overall survival [HR=1.41; 95% confidence interval (CI), 1.06-1.89; P=0.02] and recurrence-free survival (HR=1.41; 95% CI, 1.14-1.74; P=0.001). Heterogeneity among studies was not significant (overall survival: P=0.14; recurrence-free survival: P=0.28). Patients treated with hepatic resection had a significantly higher incidence of treatment-related complications (odds ratio=0.12; 95% CI, 0.03-0.47; P=0.002) and a significantly longer hospitalization duration (mean difference: -8.77; 95% CI, -10.36 to -7.18; P<0.00001) than those treated with radiofrequency ablation. Heterogeneity among studies was significant (treatment-related complications: P=0.006; hospitalization duration: P=0.003). No hospital death occurred in the 2 groups.Conclusions:Evidence from the meta-analysis of randomized controlled trials suggested that hepatic resection might improve the overall survival and recurrence-free survival in small HCC patients, whereas increase the complications and hospitalization duration. However, this conclusion should be explained with caution, due to the absence of further subgroup analysis with respect to the outcome in patients with different tumor size (<3 and 3 to 5 cm).