Xu Lin, Lin Zhenyu, Chen Dong, Huang Zhangkan, Huang Xiaozhun, Che Xu
Department of Hepatobiliary Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, China.
Front Oncol. 2024 Nov 19;14:1442499. doi: 10.3389/fonc.2024.1442499. eCollection 2024.
Minimally invasive techniques have significantly gained popularity for hepatocellular carcinoma (HCC) based on the Milan criteria. However, whether or not laparoscopic liver resection (LLR) or radiofrequency ablation (RFA) is a better treatment option remains debatable. We conducted a meta-analysis to review the published data comparing LLR and RFA for HCC through Milan criteria depending on tumor recurrence risk and survival.
PubMed, OvidSP, Web of Science, and Cochrane Library databases were searched from inception to December 31, 2023. The studies comparing the outcomes and methods between LLR and RFA for HCC within the Milan criteria were included.
We recruited 19 cohort studies with 2532 patients. The postoperative complication rate was low, and hospital stays were shorter in the RFA group than in the LLR group. The total tumor recurrence, the local tumor recurrence rate, and the intrahepatic tumor recurrence rate were lower within the LLR group than in the RFA group. There was no significant difference in the extrahepatic recurrence rate between the two groups. Moreover, no significant differences were observed between the groups concerning 1-, 3-, and 5-year overall survival (OS) and 1-year recurrence-free survival (RFS). However, 3-year and 5-year RFS were better within the LLR group than among the RFA group.
The treatment of HCC within the Milan criteria is moving toward multidisciplinary and minimally invasive approaches. Our meta-analysis identified a lower postoperative complication rate and higher recurrence rate for RFA than LLR. RFA could be an alternative treatment due to its comparable long-term efficacy with LLR.
基于米兰标准的微创技术在肝细胞癌（HCC）治疗中已显著普及。然而，腹腔镜肝切除术（LLR）和射频消融术（RFA）哪种治疗方案更佳仍存在争议。我们进行了一项荟萃分析，以回顾已发表的数据，比较根据肿瘤复发风险和生存率，通过米兰标准对HCC进行LLR和RFA治疗的情况。
检索了PubMed、OvidSP、Web of Science和Cochrane图书馆数据库，检索时间从建库至2023年12月31日。纳入了比较米兰标准内HCC的LLR和RFA治疗结果及方法的研究。
我们纳入了19项队列研究，共2532例患者。术后并发症发生率较低，RFA组的住院时间比LLR组短。LLR组的总肿瘤复发率、局部肿瘤复发率和肝内肿瘤复发率均低于RFA组。两组肝外复发率无显著差异。此外，两组在1年、3年和5年总生存率（OS）以及1年无复发生存率（RFS）方面未观察到显著差异。然而，LLR组的3年和5年RFS优于RFA组。
米兰标准内的HCC治疗正朝着多学科和微创方法发展。我们的荟萃分析表明，RFA术后并发症发生率低于LLR，但复发率高于LLR。由于RFA与LLR的长期疗效相当，它可作为一种替代治疗方法。
