Treatment strategies for solitary hepatocellular carcinoma: comparative outcomes of radiofrequency ablation vs. laparoscopic liver resection based on tumor location.

Abstract

Introduction: The treatment of early stage hepatocellular carcinoma (HCC) has become increasingly complex. This study evaluates the effectiveness of radiofrequency ablation (RFA) versus laparoscopic liver resection (LLR) for treating solitary hepatocellular carcinoma (HCC) ≤ 3 cm, with a focus on tumor location and depth.

Methods: We conducted a retrospective analysis of patients treated for solitary HCC ≤ 3 cm in the right liver lobe from 2004 to 2022. Tumor depth was categorized into three zones based on proximity to portal vein branches: Zone I (near first-order branches), Zone II (adjacent to second-order branches), and Zone III (near third-order branches). Outcomes were measured using overall survival (OS) and recurrence-free survival (RFS) rates.

Results: Of the 662 patients, for Zone I, II, and III, 240 (65 LLR, 175 RFA); 174 (100 LLR, 74 RFA); and, 248 patients were treated (244 LLR, 4 RFA), respectively. Statistically significant differences in the treatment outcomes based on the tumor depth were observed. For Zone I, LLR demonstrated superior OS (p = 0.043) and RFS rates (p = 0.030) than did RFA. For Zone II, both treatments had comparable survival outcomes, with no statistically significant differences in the OS (p = 0.460) and RFS (p = 0.358). For Zone III, LLR was principally favored, due to easier surgical access and cleaner margins.

Conclusions: This study highlighted the importance of including tumor location and depth, in addition to the tumor size and liver function, in the management of early stage HCC. A multidisciplinary approach is essential for treatment planning and optimizing survival outcomes.