Combined Hepatectomy and Radiofrequency Ablation for Multifocal Hepatocellular Carcinomas: Long-term Follow-up Results and Prognostic Factors |
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Authors: | Dongil Choi Hyo K Lim Jae-Won Joh Sung-Joo Kim Min Ju Kim Hyunchul Rhim Young-sun Kim Byung Chul Yoo Seung Woon Paik Cheol Keun Park |
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Institution: | (1) Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50, Ilwon-Dong, Kangnam-Ku, Seoul, 135-710, Republic of Korea;(2) Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50, Ilwon-Dong, Kangnam-Ku, Seoul, 135-710, Republic of Korea;(3) Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50, Ilwon-Dong, Kangnam-Ku, Seoul, 135-710, Republic of Korea;(4) Department of Diagnostic Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50, Ilwon-Dong, Kangnam-Ku, Seoul, 135-710, Republic of Korea |
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Abstract: | Background For multifocal hepatocellular carcinomas (HCCs) that are untreatable with resection only, locoregional therapies added to
hepatectomy have been introduced. However, some preliminary reports have documented average survival results and relatively
high complication rates. We evaluated the long-term survival results and safety of combined hepatectomy and radiofrequency
ablation (RFA) in patients with HCCs and assessed the prognostic factors affecting their survival.
Methods A total of 53 patients who had 148 HCCs in their livers underwent hepatectomy combined with ultrasound-guided intraoperative
RFA. The mean diameter of the 82 resected tumors was 4.8 cm (range 1.3–21.0 cm) and that of 66 ablated tumors was 1.5 cm (range
0.8–3.5 cm). We evaluated the primary effectiveness rates, survival rates, and complications. In addition, we assessed the
prognostic factors associated with the survival rates using Cox proportional hazard models.
Results The primary effectiveness rate of RFA was 98% (65 of 66). Local tumor progression was observed in two (3%) ablation zones
of 65 tumors with complete primary effectiveness. The cumulative survival rates at 1, 2, 3, 4, and 5 years were 87, 83, 80,
68, and 55%, respectively. Patients with smaller resected tumors (≤5 cm) demonstrated better survival results (P = 0.004). No procedure-related deaths occurred. We observed hepatectomy-related complications in 4 patients (8%, 4 of 53)
and an RFA-related complication in 1 patient (2%, 1 of 53).
Conclusions Combined hepatectomy and RFA is an effective and safe treatment modality for multifocal HCCs. Resected tumor size was a significant
prognostic predictor of long-term survival. |
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Keywords: | Hepatocellular Carcinoma Hepatectomy Radiofrequency Ablation Combined treatment Survival Prognostic Factors |
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