Hsieh Ching-Lung, Peng Cheng-Ming, Chen Chun-Wen, Liu Chang-Hsien, Teng Chih-Tao, Liu Yi-Jui
Department of Computer Science and Information Engineering, Feng Chia University, Taichung 40724, Taiwan.
Department of Surgery, Chung Shan Medical University Hospital, Taichung 40201, Taiwan.
World J Gastrointest Surg. 2024 Nov 27;16(11):3400-3407. doi: 10.4240/wjgs.v16.i11.3400.
The management of early stage hepatocellular carcinoma (HCC) presents significant challenges. While radiofrequency ablation (RFA) has shown safety and effectiveness in treating HCC, with lower mortality rates and shorter hospital stays, its high recurrence rate remains a significant impediment. Consequently, achieving improved survival solely through RFA is challenging, particularly in retrospective studies with inherent biases. Ultrasound is commonly used for guiding percutaneous RFA, but its low contrast can lead to missed tumors and the risk of HCC recurrence. To enhance the efficiency of ultrasound-guided percutaneous RFA, various techniques such as artificial ascites and contrast-enhanced ultrasound have been developed to facilitate complete tumor ablation. Minimally invasive surgery (MIS) offers advantages over open surgery and has gained traction in various surgical fields. Recent studies suggest that laparoscopic intraoperative RFA (IORFA) may be more effective than percutaneous RFA in terms of survival for HCC patients unsuitable for surgery, highlighting its significance. Therefore, combining MIS-IORFA with these enhanced percutaneous RFA techniques may hold greater significance for HCC treatment using the MIS-IORFA approach. This article reviews liver resection and RFA in HCC treatment, comparing their merits and proposing a trajectory involving their combination in future therapy.
早期肝细胞癌（HCC）的治疗面临重大挑战。虽然射频消融（RFA）在治疗HCC方面已显示出安全性和有效性，死亡率较低且住院时间较短，但其高复发率仍然是一个重大障碍。因此，仅通过RFA提高生存率具有挑战性，尤其是在存在固有偏差的回顾性研究中。超声通常用于引导经皮RFA，但它的低对比度可能导致肿瘤漏诊以及HCC复发风险。为提高超声引导下经皮RFA的效率，已开发出各种技术，如人工腹水和超声造影，以促进肿瘤的完全消融。微创手术（MIS）比开放手术具有优势，并在各个外科领域得到了广泛应用。最近的研究表明，对于不适合手术的HCC患者，腹腔镜术中RFA（IORFA）在生存方面可能比经皮RFA更有效，凸显了其重要性。因此，将MIS-IORFA与这些增强的经皮RFA技术相结合，对于采用MIS-IORFA方法治疗HCC可能具有更大的意义。本文综述了HCC治疗中的肝切除术和RFA，比较了它们的优点，并提出了在未来治疗中将它们结合的发展方向。
