Clinical Efficacy Of Radiofenquency-ablation Versus Reoperation For Recurrent Hepatocellular Carcinoma Meeting The Milan Criteria:a Meta Analysis

Objective:At present,postoperative recurrence of hepatocellular carcinoma is still the main cause of failure in the treatment of hepatocellular carcinoma.radiofrequency ablation(RFA)and Surgical Re-resction(SRR)have achieved similar results in the treatment of primary small hepatocellular carcinoma,but there is still controversy in the treatment of recurrent hepatocellular carcinoma.The purpose of this study was to compare the clinical efficacy of radiofrequency ablation and redo hepatic resection in the treatment of recurrent hepatocellular carcinoma meet Milan criteria after radical resection of primary liver cancer;and to provide a reference for clinicians.Methods:The clinical date published before January 2019 on the comparison of radiofenquency ablation and reoperation in patients with liver cancer who met Milan criteria for recurrence after radical resection of primary hepatocellular carcinoma were searched by computer.According to the strict inclusion conditions,the PUBMED,COCHRANE,EMBASE,knowledge network,Wanfang and other databases were searched,and there were no geographical and racial restrictions,the documents that met the inclusion criteria were screened out,and the Newcastle-OttawaScale(NOS)scale was used to evaluate the quality of the included documents and extract the data.According to the treatment method,the patients were divided into experimental group(RFA group)and control group(SRR group).The 1-year,3-year and 5-year survival rates,tumor-free survival rate,complication rate and hospital stay outcome indexes of the two groups were analyzed by REVMAN5.3 software.The effect values of each outcome index were expressed by Odd ratio(OR),Mean difference(MD)and 95%confidence interval(CI).Results:A total of 11 articles were included in the study,including 1 randomized controlled trial,1 prospective study and 9 retrospective studies.A total of 1417 patients were included,of whom 777 were treated with RFA.640 cases were treated with SRR.Meta analysis showed that there was no significant difference in the overall 1-year,3-year and 5-year survival rate and 1-year and 3-year Disease-free survival(DFS)rate between the two groups(p>0.05),but the incidence of postoperative complications in RFA group was significantly lower than that in SRR group(OR=0.15,95%CI=0.05～0.46,P=0.01),the length of stay in hospital was significantly shorter in SRR group(MD=-8.32,95%CI=-9.97～-6.67,P<0.00001),and the 5-year DFS rate in SRR group was better than that in RFA group(OR=0.45,95%CI=0.33～0.61,P<0.00001).Conclusion:For the treatment of recurrent liver cancer in accordance with Milan standard,there is no signifacant difference between the 1,3,5-year overall survival rate and 1,3-year disease-free survival rate of the two treatment.The 5-year disease-free survival rate of SRR was superior to that of RFA,but RFA has the advantages of less postoperative complications and shorter hospitalization time.