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10.1245/s10434-007-9492-7
Annals of Surgical Oncology 14:3510-3518 (2007)
© 2007 Society of Surgical Oncology
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Original Article

Combined Hepatectomy and Radiofrequency Ablation for Multifocal Hepatocellular Carcinomas: Long-term Follow-up Results and Prognostic Factors

Dongil Choi, MD1, Hyo K. Lim, MD1, Jae-Won Joh, MD2, Sung-Joo Kim, MD2, Min Ju Kim, MD1, Hyunchul Rhim, MD1, Young-sun Kim, MD1, Byung Chul Yoo, MD3, Seung Woon Paik, MD3 and Cheol Keun Park, MD4

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

Correspondence: Address correspondence and reprint requests to: Hyo K. Lim, MD; E-mail: hyokeun.lim{at}smasung.com

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.

Key Words: Hepatocellular Carcinoma • Hepatectomy • Radiofrequency Ablation • Combined treatment • Survival • Prognostic Factors






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