Clin Mol Hepatol.  2019 Dec;25(4):354-359. 10.3350/cmh.2018.0096.

Appropriate treatment modality for solitary small hepatocellular carcinoma: Radiofrequency ablation vs. resection vs. transplantation?

Affiliations
  • 1Division of Hepatobiliary-Pancreatic Surgery, Department of Surgery, Keimyung University Dongsan Medical Center, Daegu, Korea. kjkang@dsmc.or.kr

Abstract

There has been controversy regarding the first-line treatment modality for the patients who have small solitary hepatocellular carcinoma (HCC); radiofrequency ablation (RFA) or percutaneous ethanol injection (PEI), surgical hepatic resection (HR) and liver transplantation (LT). For selection of treatment modality of HCC, it should be considered of hepatic reservoir function as well as the tumor stage. If the liver function is good enough, HR may be the first choice regardless of the tumor size. However, recent studies comparing RFA with resection showed comparable outcome and similar survival rates. RFA, HR and LT provide good outcome for patients who have small HCCs. RFA would be desired in patients who have below 3.0 cm in size and low alpha-fetoprotein (<200 ng/mL). However, in small HCC with high tumor marker, HR should be considered. Better patient selection for the "Ëśresection first' approach and early detection of recurrence can achieve better outcomes of the salvage LT strategy. Another benefit of resection first strategy is that it make possible to do enlist of LT for patients before recurrence at high risk of HCC recurrence after resection on the basis of pathologic aggressiveness, microvascular invasion and/or satellites nodule. They should be applied appropriately according to the tumor size, location, tumor markers and underlying liver parenchymal disease.

Keyword

Hepatocellular carcinoma; Hepatectomy; Radiofrequency ablation; Liver transplantation

MeSH Terms

alpha-Fetoproteins
Biomarkers, Tumor
Carcinoma, Hepatocellular*
Catheter Ablation*
Ethanol
Hepatectomy
Humans
Liver
Liver Transplantation
Patient Selection
Recurrence
Survival Rate
Biomarkers, Tumor
Ethanol
alpha-Fetoproteins
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