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Abstract Details
Laparoscopic surgery versus radiofrequency ablation for the treatment of single hepatocellular carcinoma =3 cm in the elderly: a propensity score matching analysis
HPB (Oxford). 2021 Jun 8;S1365-182X(21)00159-3. doi: 10.1016/j.hpb.2021.05.008.Online ahead of print.
Maria Conticchio1, Antonella Delvecchio1, Francesca Ratti2, Maximiliano Gelli3, Ferdinando M Anelli4, Alexis Laurent5, Giulio C Vitali6, Paolo Magistri7, Giacomo Assirati7, Emanuele Felli8, Taiga Wakabayashi8, Patrick Pessaux8, Tullio Piardi9, Fabrizio Di Benedetto7, Nicola de'Angelis5, Delgado F Javier Briceno4, Antonio G Rampoldi10, René Adam11, Daniel Cherqui11, Luca Aldrighetti2, Riccardo Memeo12
Author information
1Department of Emergency and Organ Transplantation, University "Aldo Moro" of Bari, Bari, Italy.
2Hepatobiliary Surgery, San Raffaele Hospital, Milan, Italy.
3Département de Chirurgie Viscérale, Gustave Roussy Cancer Campus Grand Paris, Villejuif, France.
4Unit of Oncologic and Pancreatic Surgery, Hospital University Reina Sofía, Córdoba, Spain.
5Assistance Publique - Hôpitaux de Paris (AP-HP), Department of Digestive and Hepatobiliary Surgery, Centre hospitalier universitaire Henri Mondor, Créteil, France.
6Service of Abdominal Surgery, Geneva University Hospitals and Medical School, Geneva, Switzerland.
7Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Modena, Italy.
8Institut de Recherche contre les Cancers de l'Appareil Digestif (IRCAD), Strasbourg, France.
9Department of Surgery, Hôpital Robert Debré, Reims, France.
10Interventional Radiology Unit, Niguarda Hospital, Milan, Italy.
11Department of Surgery, Centre Hépatobiliaire, Hôpital Paul Brousse, Villejuif, France.
12Division of Hepato-Pancreato-Biliary Surgery, "F. Miulli" General Hospital, Acquaviva delle Fonti, Bari, Italy. Electronic address: r.memeo@miulli.it.
Abstract
Background: Laparoscopic liver resection (LLR) and radiofrequency ablation (RFA) represented potential treatments for patients with a single hepatocellular carcinoma (HCC) smaller than 3 cm. As the aging population soared, our study aimed to examine the advantage/drawback balance for these treatments, which should be reassessed in elderly patients.
Methods: A multicentric retrospective study compared 184 elderly patients (aged >70 years) (86 patients underwent LLR and 98 had RFA) with single ≤3 cm HCC, observed from January 2009 to January 2019.
Results: After propensity score matching (PSM), the estimated 1- and 3-year overall survival rates were 96.5 and 87.9% for the LLR group, and 94.6 and 68.1% for the RFA group (p = 0.001) respectively. The estimated 1- and 3-year disease-free survival rates were 92.5 and 67.4% for the LLR group, and 68.5 and 36.9% for the RFA group (p = 0.001). Patients with HCC of anterolateral segments were more often treated with laparoscopic resection (47 vs. 36, p = 0.04). The median operative time in the resection group was 205 min and 25 min in the RFA group (p = 0.01). Length of hospital stay was 5 days in the resection group and 3 days in the RFA group (p = 0.03).
Conclusion: Despite a longer length of hospital stay and operative time, LLR guarantees a comparable postoperative course and a better overall and disease-free survival in elderly patients with single HCC (≤3 cm), located in anterolateral segments.