Benefits and drawbacks of radiofrequency ablation via percutaneous or minimally invasive surgery for treating hepatocellular carcinoma

Abstract

The management of early stage hepatocellular carcinoma (HCC) presents significant challenges. While radiofrequency ablation (RFA) has shown safety and effectiveness in treating HCC, with lower mortality rates and shorter hospital stays, its high recurrence rate remains a significant impediment. Consequently, achieving improved survival solely through RFA is challenging, particularly in retrospective studies with inherent biases. Ultrasound is commonly used for guiding percutaneous RFA, but its low contrast can lead to missed tumors and the risk of HCC recurrence. To enhance the efficiency of ultrasound-guided percutaneous RFA, various techniques such as artificial ascites and contrast-enhanced ultrasound have been developed to facilitate complete tumor ablation. Minimally invasive surgery (MIS) offers advantages over open surgery and has gained traction in various surgical fields. Recent studies suggest that laparoscopic intraoperative RFA (IORFA) may be more effective than percutaneous RFA in terms of survival for HCC patients unsuitable for surgery, highlighting its significance. Therefore, combining MIS-IORFA with these enhanced percutaneous RFA techniques may hold greater significance for HCC treatment using the MIS-IORFA approach. This article reviews liver resection and RFA in HCC treatment, comparing their merits and proposing a trajectory involving their combination in future therapy.

Keywords: Contrast-enhanced ultrasound; Hepatocellular carcinoma; Intraoperative radiofrequency ablation; Minimally invasive surgery; Percutaneous radiofrequency ablation.