Improved outcomes with surgery compared to radiofrequency ablation in the treatment of resectable hepatocellular carcinoma.

Background While overall cancer incidence and mortality have decreased over the last decade, hepatocellular carcinoma (HCC) cases have increased sharply. Objective This study set out to evaluate the utility of surgery for resectable single tumor HCC in this setting. Patients and methods This study analyzed the National Cancer Database, selecting all patients with a histological diagnosis of HCC and an isolated tumor (<= 5 cm) treated with radiofrequency ablation (RFA) or surgical resection. Results A total of 7821 patients were identified for this study. In the patients with a single tumor up to 3 cm, 40% had a surgical resection and 60% had RFA. In the group with a tumor 3.01-5 cm, 62% had a surgical resection and 38% had RFA. Patients with a single tumor up to 5 cm had a 3-year survival of 60% after resection compared to 42% with RFA. When the patients were split into those with a tumor up to 3 cm or a tumor 3.01-5 cm, there was a survival benefit in the surgical resection cohort. Conclusion Surgical resection may be underutilized in the USA for resectable HCC, especially in patients with a tumor up to 3 cm.