Comparison of clinical efficacy between surgical re-resection and radiofrequency ablation for recurrent hepatocellular carcinoma: a Meta-analysis

Objective To compare the difference of clinical efficacy between surgical re-resection (SRR) and radiofrequency ablation (RFA) for recurrent hepatocellular carcinoma (HCC). Methods Literature from the databases Medline, PubMed, Cochrane, CNKI, CBM, Wangfang and VIP between January 2010 and January 2016 was searched. The English keywords were hepatocellular carcinoma, hepatic carcinoma, liver cancer, liver neoplasms, HCC, recurrent, recurrence, relapse, recurring, resection, hepatectomy, radio frequency ablation, ablation, radio frequency, radio-frequency, RFA and PRFA. And the Chinese keywords were liver cancer, hepatocellular carcinoma, liver neoplasms, recurrence, surgery and RFA. The patients were divided into the SRR group and RFA group. The outcome indicators including the 3-year survival rate, 3-year tumor-free survival rate, 3-year recurrence rate, incidence of complications and length of hospital stay after surgery of two groups were analyzed using Meta-analysis. Results A total of 8 literatures, 856 patients were included in this study, including 1 randomized controlled trial and 7 retrospective studies. The Meta-analysis results revealed that no significant difference was observed in the 3-year survival rate between two groups (OR=1.02, 95%CI: 0.75-1.39, P>0.05). The 3-year tumor-free survival rate in the SSR group was significantly higher than that in the RFA group (OR=1.63, 95%CI: 1.05-2.54, P 0.05). The incidence of complications above Clavien grade Ⅱ after surgery in the SRR group was significantly higher than that in the RFA group (OR=13.33, 95%CI: 2.43-73.06, P<0.05). The length of hospital stay in the SRR group was significantly longer than that in the RFA group (SMD=5.23, 95%CI: 2.85-7.61, P<0.05). Conclusions For the treatment of recurrent HCC, there is no significant difference in the overall survival rate between SRR and RFA, but the tumor-free survival rate in the SRR group is significantly higher than that in the RFA group, whereas RFA has the advantages of higher safety and shorter length of hospital stay. Key words: Carcinoma, hepatocellular; Reoperation; Catheter ablation; Meta-analysis