RESEZIONE EPATICA VS ABLAZIONE LAPAROSCOPICA NEL TRATTAMENTO DEL “VERY EARLY” HEPATOCELLULAR CARCINOMA

ABSTRACT Background The optimal treatment for patients with single, small hepatocellular carcinoma (≤ 2 cm) is still a matter of debate. The Barcelona Clinic Liver Cancer staging system suggested that percutaneous radiofrequency ablation (RFA) could be the first line treatment of choice. Nevertheless, this option is not feasible in several cases mainly for difficult nodule localization. Aims This study aims to assess whether laparoscopic ablation therapies (LATs) or hepatic resection could be considered as a reasonable alternative for patients ineligible for percutaneous procedures. Methods Propensity case-matched analysis was used to generate (out of a retrospective cohort of 176 patents with small hepatocellular carcinoma up to 2 cm in size), two homogeneous groups of 76 patients each and treated by hepatic resection or laparoscopic ablation. Overall survival, disease free survival and patterns of recurrence were compared within the two groups. Results As suggested by multivariate analysis, type of procedure, intraoperative restag-ing and preoperative values of MELD score and α –fetoprotein were associated with survival. Surgical treatment was the only factor able to independently predict intra-hepatic recurrence. The 5-year overall survival rate were 69% and 48% after liver resection and ablation therapies respectively (p = 0.0006). The 5-year recur-rence rates (80% vs. 60%; p = 0.0014) were significantly higher in the ablation therapies group as well as local recurrence (p = 0.005) and intra-segmental recurrence type (p = 0.0001). Conclusions When percutaneous ablation is not feasible, hepatic resection is the best option for the treatment of small HCC, especially in case of preserved liver function and peripherally located tumours. Laparoscopic ablation is a valid option in case of deeply located tumours, contacts with other visceral structures or severe portal hypertensaion.