Percutaneous ablation for small hepatocellular carcinoma.

Area of Science:

• Hepatology
• Interventional Oncology
• Surgical Oncology

Background:

• Hepatocellular carcinoma (HCC) is increasingly diagnosed at early stages, often 5 cm or smaller.
• Percutaneous ablation techniques are established treatments for small HCC, particularly in patients ineligible for surgery or transplantation.

Purpose of the Study:

• To review the current status of percutaneous ablation for small hepatocellular carcinoma.
• To compare the efficacy of various ablation modalities and contrast them with surgical resection.

Main Methods:

• Review of existing literature, including randomized controlled trials and retrospective studies.
• Analysis of data comparing ethanol injection, radiofrequency ablation, microwave ablation, and laser ablation for small HCC.
• Comparison of percutaneous ablation outcomes with surgical resection.

Main Results:

• Ethanol injection achieves 70-80% complete response and 40-60% 5-year survival for HCC ≤3 cm.
• Radiofrequency ablation demonstrates superior complete response rates and survival compared to ethanol injection.
• Microwave ablation shows comparable efficacy and long-term outcomes to radiofrequency ablation.

Conclusions:

• Percutaneous ablation is a widely accepted treatment for small HCC in non-surgical candidates.
• While effective, the superiority of percutaneous ablation over surgical resection for first-line treatment remains under debate due to limited robust comparative data.