Radio-frequency ablation versus hepatic surgery for the treatment of hepatocellular carcinoma: a systematic review and meta-analysis

Background Hepatocellular carcinoma (HCC) is the most common malignant tumor composed of cells resembling hepatocytes. It is the fourth most common cause of cancer□related death on earth. Treatment involves radio frequency ablation (RFA)or hepatic resection (HR). This is a review & evaluation of evidence comparing either methods by using meta-analysis technique. Materials and methods We conducted a database search of the PUBMED, GOOGLE SCHOLAR, Cochrane, EMBASE etc. in which total of 36 observational studies and 3 RCTs following PRISMA guidelines till September 2020 and matching inclusion and exclusion criteria were collected. These studies include total 16,700 patients out of which 8565 were treated with RFA & 8135 with surgery. The following search strings were used: “ RFA vs HR”, “hepatocellular carcinoma treatment “. The primary end point was overall survival rate in 3&5 years respectively, including hospital stay duration & local recurrence. RevMan 5.3 was used for appropriate statistical tests. Fixed and Random Effect Model Tests was used and p<0.05 was considered statistically significant. Results Meta-analysis showed that RFA was associated with significant decrease in the length of hospital stay for RCTs (SMD = -2.171, CI = -2.381 to - 1.962, p=<0.001) and non-RCTs (SMD = -1.048, CI = 1.492 to -0.937, p=<0.001) respectively. However, it was also associated with significant increase incidence of recurrence (RR = 1.749, 95% CI = 1.444 to 2.119, p=<0.001) and significantly poorer 3-year (RR = 0.850, 95% CI = 0.772 to 0.935, p=0.001); (RR = 0.941, 95%CI = 0.927 to 0.956, p=<0.001) survival chances for RCTs and non-RCTs respectively. 5-year survivability was (RR=0.856, 95% CI = 0.835 to 0.878, p=0.001). Conclusion Although RFA was associated with decreased duration of hospital stay, it was associated with increased chances of recurrence compared to hepatic resection. 3-year survival rate was also poorer.