| Background: Primary liver cancer(PHC), featuring high malignant degree and poor prognosis, is one of major life-threatening diseases. Approximately half of all the PHCs occurred in China, therefore, the diagnosis and treatment of PHC is one of the major tasks for domestic medical workers. Surgical resection is the primary treatment for early PHC currently. However, due to the large surgical trauma, more complications for elderly patients as well as high surgical risk, some patients have fears about the surgery. Also, a non-operative combined therapy may also be required as for a large number of tumors, unresectable tumor location, insufficient hepatic reserve, etc. Among the non-surgical treatments, radiofrequency ablation(RFA) has emerged as one of the most common hyperthermia methods. In recent years, with the transformation of medical model, studies on quality of life(QOL), humane care and social benefits of cancer patients has aroused in-depth discussion among the medical workers.Objectives: By adopting Doppler ultrasonography as RFA guidance, to discuss the short-term prognosis and quality of life of patients with PHC treated with RFA and traditional surgery, and evaluate both the two treatment methods in terms of complications, treatment time, economic cost as well as QOL, thereby offering data for the selection of more optimized therapeutic schemes.Materials and methods: 109 patients with PHC confirmed from November 2013 to December 2014 were enrolled, among which, 51 patients(aging from 38 to 78 years old, median age of 58 years old,The average age is 60 ± 8.7 years old) received both Doppler ultrasonography and RFA, and there were 30 patients with single lesion, and 21 patients with two or more lesions, totaling 79 lesions(The average size of the lesion was 3.2±1.5 cm). Maximum diameters of all lesions were less than or equal to 5cm, the smallest lesion was1.4cm, and number of multiple lesions was up to 3. 58 patients were selected in surgical treatment group, aging from 40 to 69 years old, with median age of 54.5. The average age is 49 ±7.8 years old, And there were 44 patients with single lesion, and 14 patients with multiple lesions; the maximum lesion diameter was 5cm, and number of multiple lesions was up to 2, totaling 72 lesions. All patients were diagnosed with PHC based on their pathology, meanwhile Doppler ultrasonography and enhanced CT scan were provided to determine numbers, sizes and sites of lesions as well as blood supply. All patients received AFP, liver function examination, etc., while some patients were also given with MRI scan for making definite diagnosis. RFA equipment used were the RITA 1500 RF Generator(from USA) and 15 G multi-electrode RF needle, built in with 9 fine-needle electrodes equipping with multiple electrode cables; the main unit power was 150 W, and generator frequency 460 k Hz. GE vivid7 ultrasound system was used to guide puncture, with frequency of 3. 5 MHz.Patients were prohibited water drinking for 6h before surgery treatment and RFA treatment. Detailed ultrasonography and spiral CT scan were given to determine liver lesions, and develop reasonable surgery program, approach, needle insertion path and needle placement. Necessary liver function assessment was also performed to ascertain liver reserve capacity, control indication of surgery; general anesthesia, local anesthesia at puncture point, intravenous analgesia, intravenous anesthesia, etc. were then selected according to the surgery program.Comprehensive ultrasonography was done again before RFA, to ascertain needle insertion point, angle and needle placement; try to pass through the normal site of liver and then into the rumor.(Needle was inserted from intercostal space, and puncture should be accurate with guidance of ultrasonography, as repeated punctures would cause tumor deposit, damages of adjacent tissues(including blood vessels, intrahepatic bile duct) or rupture and bleeding of tumor; electrode needled should not be retreated after deep insertion, but shall withdraw and relocate after in-situ ablation, to avoid tumor deposit. Deep-seated tumors should be firstly ablated, then the shallow-seated tumors. To ensure the effects of ablation therapy, ultrasonography was done again before end of treatment for comprehensive liver scan, while ablation zone covered the entire area of the tumor with a safe margin of 0.5cm. The possibilities of complications such as tumor rapture, bleeding, hemothorax/pneumothorax, etc. were excluded. Overlapping ablation of one-needle multi-point may ensure the ablation zone and reduce possibility of hollow; needle passage ablation was required before remove, to prevent postoperative bleeding and tumor deposit along the passage. Radical local liver resection was performed on patients of resection, in which, intermittent hepatic portal occlusion was performed under normal temperature, and portal vein interruption interval was strictly controlled as 10-15 min per time; in case the hepatic tissue was failed to be resected at one time, porta hepatis blood supply was then opened for secondary resection after 5min. During resection, pinching with fingers along with pliers clamp or ultrasonic scalpel and ligasure were adopted for liver transection; intrahepatic vessels and bile ducts were ligated, double ligature for great vessels, and excessive traction was not allowed when approaching inferior vena cava, so as to avoid damaging to retrohepatic vena cava and inferior vena cava. Liver transection surface was stitched in bedding mean and cauterized with HF electrical unit or argon beam coagulator, and section was sealed with chemical bond to reduce bleeding.Results: 1. Number of patients appearing complications after operation and before discharge in RFA group was less than that of surgical treatment group, showing statistical significance,(P=0.04,<0.05). 2. QOL score of RFA group on 3rd postoperative day was greater than surgery group, presenting statistically significant difference, P<0.05(P=0.03). 3.Biochemical examinations(liver function) were performed to the patients of the two groups on the 3rd postoperative day and 2nd postoperative month, for which, the improvement rate of liver function examination conducted on 3rd postoperative day was higher than surgical group, as(P=0.03,<0.05); there was no statistically significant difference between the two groups in total improvement rates as indicated in the liver function re-examination on 2nd postoperative month, presenting no statistically significant difference,(P=0.32, >0.05). 4. For the total remission rate of response evaluation criteria in solid tumors or WHO criteria, the two groups had no statistically significant difference,(P=0.41, >0.05). 5. Color doppler ultrasound, CT scan and MRI were performed on patients on the 3rd postoperative day and 2nd postoperative month, and both groups showed no statistically significant difference in terms of imaging improvement(Respectively P = 0.91, P = 0.86,> 0.05).Conclusion: a) RFA has same effects with the surgery treatment in treating the PHC with diameter less than 5cm, and features unique advantage especially to the PHC of less than 3cm. b) With respect to quality of life, therapeutic effect of RFA is superior to the surgery treatment for PHC with diameter less than 5cm, and is also characterized by less pain, low cost and favorable effect. Therefore, RFA can be the preferred treatment method for PHC less than 5cm in diameter from the perspective of economic benefit, social benefit and clinical value. |
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