Combined major liver resection and radiofrequency ablation for multifocal hepatocellular carcinoma

Abstract

BACKGROUND: Multifocal hepatocellular carcinoma (HCC) remained a difficult condition to be treated, as patients may be out of liver transplantation criteria, as well as inadequate liver remnant to undergo major hepatectomy. This study aimed to review the outcome of the patents undergoing combined resection and radiofrequency ablation (RFA). METHODS: From January 2001 to December 2013, the postoperative and oncological outcomes of all patients who had undergone major liver resection and RFA for multifocal HCC in Queen Mary Hospital, Hong Kong, were reviewed. The baseline characteristics was matched by propensity score matching in a ratio of 1:8. Survival analysis was performed by Kaplan Meier methods and compared between subgroup with log-rank test. Risk factors affecting survival were determined by Cox regression model. RESULTS: A total of 16 patients undergoing major liver resection and RFA for multifocal were matched with 128 patients undergoing major resection alone during the study period. There were no difference in terms of the baseline characteristics, comorbidities. Patients in both groups had similar Child Pugh grading and MELD score. In spite of the higher ICG retention rate at 15 minutes for the combined group, it was still within the normal range (12.7% vs. 10.6%, p = 0.026). Both groups of patients suffered from similar number of tumors, but only 47 patients (36.7%) were bilobar in the liver resection group. There were no difference in terms of the operative procedures, outcome and hospital stay, neither the pathology of the tumors. Despite the multifocality of the HCC and bilobar involvement, combined resection resulted in similar overall survival (5-year 24.1% vs. 40.1%, p = 0.164). Prolonged hospital stay and tumor with microvascular invasion were the risk factors for poorer overall survival. CONCLUSION: Aggressive management of HCC with combination modalities, such as liver resection and RFA, should always be considered for bilobar multifocal HCC.