Improved outcomes with surgery compared to radiofrequency ablation in the treatment of resectable hepatocellular carcinoma.

BACKGROUND:While overall cancer incidence and mortality have decreased over the last decade, hepatocellular carcinoma (HCC) cases have increased sharply. OBJECTIVE:This study set out to evaluate the utility of surgery for resectable single tumor HCC in this setting. PATIENTS AND METHODS:This study analyzed the National Cancer Database, selecting all patients with a histological diagnosis of HCC and an isolated tumor (≤5 cm) treated with radiofrequency ablation (RFA) or surgical resection. RESULTS:A total of 7821 patients were identified for this study. In the patients with a single tumor up to 3 cm, 40% had a surgical resection and 60% had RFA. In the group with a tumor 3.01-5 cm, 62% had a surgical resection and 38% had RFA. Patients with a single tumor up to 5 cm had a 3-year survival of 60% after resection compared to 42% with RFA. When the patients were split into those with a tumor up to 3 cm or a tumor 3.01-5 cm, there was a survival benefit in the surgical resection cohort. CONCLUSION:Surgical resection may be underutilized in the USA for resectable HCC, especially in patients with a tumor up to 3 cm