| Objective:With the rapid development and continuous improvement of liver surgery techniques, surgical comprehensive treatment have improved. The treatment effect in patients with hepatocellular carcinoma have improved to some extent However, the recurrence rate is still high, and has become an important factors affecting long-term survival of patients with hepatocellular carcinoma. Statistical data show that after 3-year recurrence rate of up to 57%-81%. Currently, surgical resection and local radiofrequency ablation is the primary means of recurrent small hepatocellular carcinoma. However, what should be the preferred treatment method currently is still controversial! This paper aims to evaluate the recurrence of re-resection and radiofrequency ablation in patients with hepatocellular carcinoma of prognostic influence in line with the Milan criteria in the system.Method:Developing and following strictly inclusion and exclusion criteria of literature, search from databases of foreign language such as Medline, the Cochrane Central, PubMed, Register of Controlled Trials and VIP, and Chinese database such as Chinese Academic Journal (CNKI), Articles database, Chinese Biomedical literature Database (CBM), etc. about recurrent hepatocellular carcinoma published papers or conference of paperssurgery and radiofrequency ablatioa Use Newcastle-Ottawa Scale (NOS) Scale to evaluate the quality of the included literature, to exclude the poor quality of the literature and use a unified document information extraction to extract data table. The selected 3-year survival is the main outcome measure; 3-year recurrence rate with surgery, above Clavien â…¡ level, complication rates and length of stay are as the secondary outcomes. Applicate RevMan5.2 software to extract data for statistical analysis. With reference to the results of data extraction and statistical analysis outcome of included literature tto draw forest map, use the odds ratio (Odd ratio, OR) and 95% confidence intervals (Confidence interval, CI) represents count data; Measurement data expressed in the weighted mean difference (Mean difference, MD) and 95%confidence intervals (Confidence interval, CI).Result:Literature search were obtained 714 documents, obtained 74 documents after the initial screening, further obtained 8 documents met the inclusion criteria after reading a total of full-text literature, including a prospective study of literature for randomized controlled trials (Randomized controlled trial, RCT),7 documents of retrospective analysis. The quality of literature is good on the whole. In eight literature, there have reported a total of 856 patients, including 345 people of surgical re-excision group, and 511 people of radiofrequency ablation group. Meta-analysis of the included studies, the result is:in the treatment of recurrent small hepatocellular carcinoma:(1) The differences between surgical resection and radiofrequency ablation treatment for overall survival rate about 3-year after surgery again is not statistically significant, the results of [OR= 1.02 (95% CI:0.75,1.39), P= 0.90]; (2) The complication rate of radiofrequency ablation above 3-year disease free survival is significantly lower than the surgery again, the result is [OR= 1.63 (95%CI:1.05,2.54), P<0.05]; (3) The differences between surgical resection and radiofrequency ablation treatment for recurrence rate about 3-year after surgery again is at the same time not statistically significant, the results of [OR= 0.85 (95% CI:0.48,1.49), P= 0.57]; (4) The complication rate of radiofrequency ablation above Clavien II level is significantly lower than the surgery again, the result is [OR= 13.33 (95% CI:2.43,73.06), P<0.01]; (5) Compared with surgical resection again, radiofrequency ablation can significantly reduce the length of stay of patients, the results of [MD= 5.23 (95% CI:2.85,7.61), P <0.01].Conclusion:For the treatment of recurrent hepatocellular carcinoma in line with the Milan criteria, re-resection has no significant difference compared with the clinical efficacy of radiofrequency ablation with the same 3-year overall survival rate. But re-resection is better than radiofrequency in the part of 3-year disease free survival rate. However RFA has the advantages of relatively high clinical safety, shorter hospital stay, minimally invasive and repeatable operation. So with the HCC patients met the Mian criteria for recurrent, we should think more between these two methods and cure patients personalized. |
PDF Full Text Request