Repeat resection versus percutaneous ablation for recurrent hepatocellular carcinoma: a meta-analysis

Area of Science:

• Hepatology and oncology
• Interventional radiology
• Surgical oncology

Background:

• Recurrent hepatocellular carcinoma (rHCC) presents treatment challenges.
• Both repeat resection (RR) and percutaneous ablation (PA) are established treatment modalities for rHCC.
• Each treatment method possesses distinct advantages and disadvantages.

Purpose of the Study:

• To conduct a meta-analysis comparing the safety and effectiveness of RR versus PA in patients diagnosed with rHCC.
• To evaluate key outcomes including overall survival, disease-free survival, recurrence rates, complication rates, and hospitalization duration.

Main Methods:

• A systematic literature search was performed across PubMed, Embase, Wanfang, and CNKI databases, including studies published up to April 2022.
• The meta-analysis focused on primary endpoints of overall survival (OS) and disease-free survival (DFS).
• Secondary endpoints included rates of repeat recurrence, complication severity (Grades 1/2 and 3/4), and duration of hospitalization.

Main Results:

• While repeat recurrence rates were comparable (p=0.09), repeat resection (RR) showed significantly higher pooled 5-year DFS (p=0.01), DFS duration (p=0.02), and 3-year OS (p=0.04) compared to percutaneous ablation (PA).
• Percutaneous ablation (PA) demonstrated significantly lower pooled rates for both Grade 1/2 (p=0.04) and Grade 3/4 (p=0.001) complications.
• PA was associated with a significantly shorter hospitalization duration (p=0.0002) compared to RR.

Conclusions:

• Repeat resection (RR) may offer superior long-term disease control for recurrent hepatocellular carcinoma (rHCC) patients.
• Percutaneous ablation (PA) presents a favorable safety profile and leads to shorter hospitalizations.
• The choice between RR and PA for rHCC should consider the balance between long-term efficacy and treatment safety/recovery.