CT-guided versus laparoscopic radiofrequency ablation in recurrent small hepatocellular carcinoma against the diaphragmatic dome

Abstract

Computed tomography-guided radiofrequency ablation (CT-RFA) and laparoscopic RFA (L-RFA) have been used to treat intrahepatic recurrent small hepatocellular carcinoma (HCC) against the diaphragmatic dome. However, the therapeutic safety, efficacy, and hospital fee have never been compared between the two techniques due to scarcity of cases. In this retrospective study, 116 patients were divided into two groups with a total of 151 local recurrent HCC lesions abutting the diaphragm. We compared overall survival (OS), local tumor progression (LTP), postoperative complications, and hospital stay and fee between the two groups. Our findings revealed no significant differences in 5-year OS (36.7% vs. 44.6%, p = 0.4289) or 5-year LTP (73.3% vs. 67.9%, p = 0.8897) between CT-RFA and L-RFA. The overall hospital stay (2.8 days vs. 4.1 days, p < 0.0001) and cost (¥ 19217.6 vs. ¥ 25553.6, p < 0.0001) were significantly lower in the CT-RFA in comparison to that of L-RFA. In addition, we elaborated on the choice of percutaneous puncture paths depending on the locations of the HCC nodules and 11-year experience with CT-RFA. In conclusion, CT-RFA is a relatively easy and economic technique for recurrent small HCC abutting the diaphragm, and both CT-RFA and L-RFA are effective techniques.

Figure 1. Kaplan-Meier curves of overall survival rates of CT-RFA and L-RFA treated groups of patients with recurrent HCC against the diaphragmatic dome.

There was no significant difference between the two groups (p = 0.5486).

Figure 2. Kaplan-Meier curves of local tumor progression of CT-RFA- and L-RFA-treated groups of patients with recurrent HCC against the diaphragmatic dome.

There was no significant difference between the two groups (p = 0.5335).

Figure 3. Different puncture paths for ablating nodules at various positions.

(A) A recurrent small HCC in zone A (arrowhead) was found in a 36-year-old male patient who underwent TACE treatment 8 months previously; no viable tumor was found in the 4-year postoperative CT scan image. (B) a recurrent small HCC in zone B (arrowhead) was found in a 61-year-old male patient who underwent hepatectomy 4 years previously; no viable tumor was found in the 2-year postoperative CT scan image. (C) a recurrent small HCC in zone C (arrowhead) was found in a 42-year-old female patient who underwent hepatectomy 1 year previously; no viable tumor was found in the 1-year postoperative CT scan image. (D) a recurrent small HCC in zone D (arrowhead) was found in a 52-year-old male patient who underwent TACE treatment 3 months previously; no viable tumor was found in the 6-month postoperative CT scan image.