American Journal of Cancer Prevention
ISSN (Print): 2328-7314 ISSN (Online): 2328-7322 Website: Editor-in-chief: Nabil Abdel-Hamid
Open Access
Journal Browser
American Journal of Cancer Prevention. 2016, 4(1), 13-17
DOI: 10.12691/ajcp-4-1-3
Open AccessMeta-Analysis

Percutaneous Radiofrequency Ablation versus Surgical Resection for the Treatment of Small Hepatic Carcinoma: A Meta-analysis

Li Xin1, Yun-bing Wang2 and Jian-ping Gong3,

1Department of surgery, Dadukou District People’s Hospital, Chongqing, China

2Department of Hepatobiliary, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China

32Department of Hepatobiliary, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China

Pub. Date: April 13, 2016

Cite this paper:
Li Xin, Yun-bing Wang and Jian-ping Gong. Percutaneous Radiofrequency Ablation versus Surgical Resection for the Treatment of Small Hepatic Carcinoma: A Meta-analysis. American Journal of Cancer Prevention. 2016; 4(1):13-17. doi: 10.12691/ajcp-4-1-3


Aims: To evaluate the curative effect of percutaneous radiofrequency ablation (PRFA) versus surgical resection (SR) for the treatment of small hepatic carcinoma. Methods: Cochrane Library, Medline, Pubmed, CNKI, WanFang, VIP databases were searched from January 1990 to March 2013, then clinical control studies comparing curative effects of PRFA with SR in treatment of small hepatic carcinoma were acquired and reviewed. Qualities of these studies were evaluated. Publication bias was also assessed by using a funnel plot. Then primary outcomes, namely overall survival rates, disease-free survival rates and postoperative complication, were abstracted to conduct a combined analysis by using fixed or random effects model. Results: A total of eight studies involving 1287 patients were included in our study. The PRFA group has a lower overall survival rates over the SR group in 1 year (OR, 0.62; 95% confidence interval [CI], 0.43-0.89; P = 0.009), 3 years (OR, 0.44; 95% CI, 0.27-0.72; P=0.001), and 5 years (OR, 0.49; 95% CI, 0.35-0.68; P<0.0001). The PRFA group has a lower disease-free survival rates over the SR group in 1 year (OR, 0.63; 95% CI, 0.49-0.82; P=0.0006), 3 years (OR, 0.45; 95% CI, 0.30-0.67; P=0.0001), and 5 years (OR, 0.46; 95% CI, 0.33-0.64; P<0.00001). The postoperative complication of the PRFA group was lower than the SR group (OR, 0.21; 95% CI, 0.08-0.56; P<0.00001). Conclusion: PRFA had lower overall survival rates after surgery and disease-free survival than SR, but it has a lower incidence of postoperative complications. Then PRFA, acted as an operation with smaller invasion and shorter hospitalization time, would be a good choice for the patients with hepatic carcinoma who is reluctant to be treated by SR.

percutaneous radiofrequency ablation surgical resection hepatic carcinoma meta-analysis

Creative CommonsThis work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit


[1]  Ferlay J, Shin HR, Bray F, Forman D, Mathers C, Parkin DM, “Estimates of worldwide burden of cancer in 2008: Globocan 2008,” Int J Cancer, 127(12), 2893-2917, 2010.
[2]  Forner A, Llovet JM, Bruix J, “Hepatocellular carcinoma,” Lancet, 379(9822) , 1245-1255, 2012.
[3]  De Lope CR, Tremosini S, Forner A, Reig M, Bruix J. “Management of hcc,” J Hepatol, 56 Suppl 1(S75-87), 2012.
[4]  El-Serag HB. “Hepatocellular carcinoma,” N Engl J Med, 365(12), 1118-1127, 2011.
[5]  Bruix J, Sherman M, “Management of hepatocellular carcinoma: An update,” Hepatology, 53(3), 1020-1022, 2011.
[6]  Zarrinpar A, Kaldas F, Busuttil RW. “Liver transplantation for hepatocellular carcinoma: An update,” Hepatobiliary Pancreat Dis Int, 10(3), 234-242, 2011.
[7]  Llovet JM, Bruix J. “Novel advancements in the management of hepatocellular carcinoma in 2008,” J Hepatol, 48 Suppl 1(S20-37), 2008.
[8]  Benson AB 3rd, Abrams TA, Ben-Josef E, Bloomston PM, Botha JF, Clary BM, Covey A, Curley SA, D'Angelica MI, Davila R, Ensminger WD, Gibbs JF, Laheru D, Malafa MP, Marrero J, Meranze SG, Mulvihill SJ, Park JO, Posey JA, Sachdev J, Salem R, Sigurdson ER, Sofocleous C, Vauthey JN,Venook AP, Goff LW, Yen Y, Zhu AX. “Nccn clinical practice guidelines in oncology: Hepatobiliary cancers,” J Natl Compr Canc Netw, 7(4), 350-391, 2009.
[9]  Huo TI, Huang YH, Huang HC, Wu JC, Lee PC, Chang FY, Lee SD. “Fever and infectious complications after percutaneous acetic acid injection therapy for hepatocellular carcinoma: Incidence and risk factor analysis,” J Clin Gastroenterol, 40(7) , 639-642, 2006.
[10]  Zhang YY, Xia HH. “Novel therapeutic approaches for hepatocellulcar carcinoma: Fact and fiction,” World J Gastroenterol, 14(11) , 1641-1642, 2008.
[11]  Ni S, Liu L, Shu Y. “Sequential transcatheter arterial chemoembolization, three-dimensional conformal radiotherapy, and high-intensity focused ultrasound treatment for unresectable hepatocellular carcinoma patients,” J Biomed Res, 26(4), 260-267, 2012.
[12]  Cha DI, Lee MW, Rhim H, Choi D, Kim YS, Lim HK. “Therapeutic efficacy and safety of percutaneous ethanol injection with or without combined radiofrequency ablation for hepatocellular carcinomas in high risk locations,” Korean J Radiol, 14(2), 240-247, 2013.
[13]  Xue T, Le F, Chen R, Xie X, Zhang L, Ge N, Chen Y, Wang Y, Zhang B, Ye S, Ren Z. “Transarterial chemoembolization for huge hepatocellular carcinoma with diameter over ten centimeters: A large cohort study,” Med Oncol, 32(3), 64, 2015.
[14]  Huang J, Yan L, Cheng Z, Wu H, Du L, Wang J, Xu Y, Zeng Y. “A randomized trial comparing radiofrequency ablation and surgical resection for hcc conforming to the milan criteria,” Ann Surg, 252(6), 903-912, 2010.
[15]  Abu-Hilal M, Primrose JN, Casaril A, McPhail MJ, Pearce NW, Nicoli N. “Surgical resection versus radiofrequency ablation in the treatment of small unifocal hepatocellular carcinoma,” J Gastrointest Surg, 12(9), 1521-1526, 2008.
[16]  Ueno S, Sakoda M, Kubo F, Hiwatashi K, Tateno T, Baba Y, Hasegawa S, Tsubouchi H. “Surgical resection versus radiofrequency ablation for small hepatocellular carcinomas within the milan criteria,” J Hepatobiliary Pancreat Surg, 16(3) , 359-366, 2009.
[17]  Chen MS, Li JQ, Zheng Y, Guo RP, Liang HH, Zhang YQ, Lin XJ, Lau WY. “A prospective randomized trial comparing percutaneous local ablative therapy and partial hepatectomy for small hepatocellular carcinoma,” Ann Surg, 243(3), 321-328, 2006.
[18]  Lü MD, Kuang M, Liang LJ, Xie XY, Peng BG, Liu GJ, Li DM, Lai JM, Li SQ. “Surgical resection versus percutaneous thermal ablation for early-stage hepatocellular carcinoma: A randomized clinical trial,” Zhonghua yi xue za zhi, 86(12), 801-805, 2006.
[19]  Feng K, Yan J, Li X, Xia F, Ma K, Wang S, Bie P, Dong J. “A randomized controlled trial of radiofrequency ablation and surgical resection in the treatment of small hepatocellular carcinoma,” J Hepatol, 57(4), 794-802, 2012.
[20]  Vivarelli M, Guglielmi A, Ruzzenente A, Cucchetti A, Bellusci R, Cordiano C, Cavallari A. “Surgical resection versus percutaneous radiofrequency ablation in the treatment of hepatocellular carcinoma on cirrhotic liver,” Ann Surg, 240(1), 102-107, 2004.
[21]  Tohme S, Geller DA, Cardinal JS, Chen HW, Packiam V, Reddy S, Steel J, Marsh JW, Tsung A. “Radiofrequency ablation compared to resection in early-stage hepatocellular carcinoma,” HPB (Oxford), 15(3), 210-217, 2013.
[22]  Mazzaferro V, Chun YS, Poon RT, Schwartz ME, Yao FY, Marsh JW, Bhoori S, Lee SG. “Liver transplantation for hepatocellular carcinoma,” Ann Surg Oncol, 15(4), 1001-1007, 2008.
[23]  Jadad AR, Moore RA, Carroll D, Jenkinson C, Reynolds DJ, Gavaghan DJ, McQuay HJ. “Assessing the quality of reports of randomized clinical trials: Is blinding necessary?,” Control Clin Trials, 17(1), 1-12, 1996.
[24]  Yim SY, Seo YS, Jung CH, Kim TH, Lee JM, Kim ES, Keum B, Jong YK, An H, Kim JH, Yim HJ, Kim DS, Jeen YT, Yeon JE, Lee HS,Chun HJ, Byun KS, Um SH, Kim CD, Ryu HS. “The management and prognosis of patients with hepatocellular carcinoma: What has changed in 20 years?,” Liver Int, 2015. [Epub ahead of print]
[25]  Zuo C, Xia M, Wu Q, Zhu H, Liu J, Liu C. “Role of antiviral therapy in reducing recurrence and improving survival in hepatitis b virus-associated hepatocellular carcinoma following curative resection (review) ,” Oncol Lett, 9(2), 527-534, 2015.
[26]  Weis S, Franke A, Berg T, Mössner J, Fleig WE, Schoppmeyer K. “Percutaneous ethanol injection or percutaneous acetic acid injection for early hepatocellular carcinoma,” Cochrane Database Syst Rev, 1, CD006745, 2015.
[27]  Wang C, Wang H, Yang W, Hu K, Xie H, Hu KQ, Bai W, Dong Z, Lu Y, Zeng Z, Lou M, Wang H, Gao X, Chang X, An L, Qu J, Li J, Yang Y. “Multicenter randomized controlled trial of percutaneous cryoablation versus radiofrequency ablation in hepatocellular carcinoma,” Hepatology, 61(5), 1579-1590, 2015.
[28]  Kudo M. “Radiofrequency ablation for hepatocellular carcinoma: Updated review in 2010,” Oncology, 78 (Suppl 1), 113-124, 2010.
[29]  Stadlbauer V, Lang-Olip I, Leber B, Mayrhauser U, Koestenbauer S, Tawdrous M, Moche M, Sereinigg M, Seider D, Iberer F, Wiederstein-Grasser I, Portugaller RH, Stiegler P. “Immunohistochemical and radiological characterization of wound healing in porcine liver after radiofrequency ablation,” Histol Histopathol, 31(1), 115-129, 2016.
[30]  Ansari D, Andersson R. “Radiofrequency ablation or percutaneous ethanol injection for the treatment of liver tumors,” World J Gastroenterol, 18(10), 1003-1008, 2012.
[31]  Wakai T, Shirai Y, Suda T, Yokoyama N, Sakata J, Cruz PV, Kawai H, Matsuda Y, Watanabe M, Aoyagi Y, Hatakeyama K. “Long-term outcomes of hepatectomy vs percutaneous ablation for treatment of hepatocellular carcinoma < or =4 cm,” World J Gastroenterol , 12(4), 546-552, 2006.
[32]  Li L, Zhang J, Liu X, Li X, Jiao B, Kang T. “Clinical outcomes of radiofrequency ablation and surgical resection for small hepatocellular carcinoma: A meta-analysis,” J Gastroenterol Hepatol, 27(1), 51-58. 2012.