Percutaneous Ethanol Injection Versus Surgical Resection for the Treatment of Small Hepatocellular Carcinoma: A Prospective Study
Resource
ANNALS OF SURGERY v.242 n.1 pp.36-42
Journal
ANNALS OF SURGERY
Journal Volume
v.242
Journal Issue
n.1
Pages
36-42
Date Issued
2005
Date
2005
Author(s)
HUANG, GUAN-TARN
LEE, PO-HUANG
TSANG, YUK-MING
LAI, MING-YANG
YANG, PEI-MING
HU, REY-HENG
CHEN, PEI-JER
KAO, JIA-HORNG
SHEU, JIN-CHUAN
LEE, CHA-ZE
CHEN, DING-SHINN
Abstract
Objective: To compare disease recurrence and survival among patients with small hepatocellular carcinoma after surgical resection or percutaneous ethanol injection therapy, 2 treatments that have not been evaluated with a prospective study. Methods: A total of 76 patients were randomly assigned to 2 groups based on treatment; all had one or 2 tumors with diameter <=3 cm, with hepatitis without cirrhosis or Child class A or B cirrhosis without evident ascites or bleeding tendency. Results: Follow-up ranged from 12 to 59 months. Among percutaneous injection patients, 18 had recurrence 1 to 37 months after treatment (true recurrence, 11; original safety margin inadequate, 3; limitation of imaging technology to detect tiny tumors, 4). Three injection therapy patients died of cancer 25 , 37, and 57 months after treatment. For the surgical resection group, 15 had recurrence 2 to 54 months after treatment (true recurrence, 12; limitation of imaging, 2; neck metastasis, 1 ). Five resection patients died of cancer at 11, 20, 23, 26, and 52 months, respectively. By Cox regression model and Kaplan-Meier survival analysis, there is no statistical significance for recurrence and survival between treatment groups. However, tumor size larger than 2 cm and alpha- fetoprotein over 200 ng/mL correlated with higher recurrence rate, and Child class B liver cirrhosis correlated with shorter survival. Conclusions: Percutaneous ethanol injection therapy appears to be as safe and effective as resection , and both treatments can be considered first-line options for small hepatocellular carcinoma.
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