Laparoscopic liver resection versus radiofrequency ablation for solitary small hepatocellular carcinoma in elderly...

The optimal local treatment for solitary small hepatocellular carcinoma in elderly patients remains unclear. This multicenter propensity score-matched study compared perioperative and long-term outcomes between laparoscopic liver resection and radiofrequency ablation in this population.

Elderly patients (defined as age ≥70 years) with solitary hepatocellular carcinoma ≤3 cm who underwent laparoscopic liver resection or radiofrequency ablation at 8 tertiary centers were included. Propensity score matching (1:1) balanced baseline characteristics. Perioperative outcomes, overall survival, and disease-free survival were compared. Independent prognostic factors were identified by Cox regression.

After propensity score matching, 102 patients were included in each group. Laparoscopic liver resection was associated with longer operative time, higher blood loss, longer hospital stay, and more overall complications (all P < .05), but 90-day mortality did not differ. Laparoscopic liver resection achieved superior overall survival (median, not reached versus 67.5 months, 5-year: 65.7% vs 50.0%; P = .005) and disease-free survival (median, 36.8 vs 21.3 months, 5-year: 40.2% vs 34.3%; P < .001). On multivariate analysis, radiofrequency ablation was an independent risk factor for worse overall survival (hazard ratio, 2.18; P = .011) and disease-free survival (hazard ratio, 2.42; P = .001). Subgroup analyses showed that the survival benefit of laparoscopic liver resection was pronounced in patients with no portal hypertension, American Society of Anesthesiologists physical status I-II, Child-Pugh A, model for end-stage liver disease ≤9, platelet >100 × 10⁹/L, albumin >35 g/L, tumor >2 cm, no lesion contact with Glissonian pedicles, and the absence of cirrhosis.

In selected elderly patients with solitary small hepatocellular carcinoma, laparoscopic liver resection provides superior long-term overall survival and disease-free survival compared with radiofrequency ablation, despite a higher rate of specific complications including posthepatectomy liver failure and ascites and a numerically higher 90-day mortality. Laparoscopic liver resection should be considered first line in surgically fit elderly patients, especially those with good performance status and favorable liver function. Radiofrequency ablation may be considered a valid alternative in patients with high surgical risks or tumors ≤2 cm, as it achieved comparable oncologic outcomes with significantly lower morbidity and faster recovery.