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• W4200505964 abstract "We were very impressed by Famularo et al.'s study on HPB, 2021, Volume 23, that carried out a multicenter survival comparison between curative treatment [surgery or radiofrequency ablation (RFA) - 156 patients] and palliative one [trans-arterial chemo-embolization (TACE) or Sorafenib - 256 patients] for patients with recurrent hepatocellular carcinoma (rHCC).1Famularo S. Donadon M. Cipriani F. Bernasconi D.P. LaBarba G. Dominioni T. et al.HE.RC.O.LE.S. GroupCurative versus palliative treatments for recurrent hepatocellular carcinoma: a multicentric weighted comparison.HPB. 2021; 23: 889-898https://doi.org/10.1016/j.hpb.2020.10.007Abstract Full Text Full Text PDF PubMed Scopus (5) Google Scholar In the curative group, Authors recorded a 1-, 2- and 5-year survivals after recurrence (SAR) and 1-, 2- and 5-year disease-free survivals (DFS) which were statistically higher than palliative group, particularly in case of only intrahepatic recurrence.1Famularo S. Donadon M. Cipriani F. Bernasconi D.P. LaBarba G. Dominioni T. et al.HE.RC.O.LE.S. GroupCurative versus palliative treatments for recurrent hepatocellular carcinoma: a multicentric weighted comparison.HPB. 2021; 23: 889-898https://doi.org/10.1016/j.hpb.2020.10.007Abstract Full Text Full Text PDF PubMed Scopus (5) Google Scholar However, which curative treatment is more effective for rHCC patients remains an open question. A recent network meta-analysis focused on the effectiveness of different therapeutic strategies had identified the following cumulative ranking plots: salvage liver tansplantation (SLT), repeat hepatectomy (RH), stereotactic body radiation therapy (SBRT), RFA, TACE for overall survival (OS) and SLT, RH, RFA, SBRT, TACE for DFS.2Zheng J. Cai J. Tao L. Kirih M.A. Shen Z. Xu J. et al.Comparison on the efficacy and prognosis of different strategies for intrahepatic recurrent hepatocellular carcinoma: a systematic review and Bayesian network meta-analysis.Int J Surg. 2020; 83: 196-204https://doi.org/10.1016/j.ijsu.2020.09.031Crossref PubMed Scopus (19) Google Scholar In terms of OS and DFS, the above mentioned study indicated that RFA therapeutic effect was lower than that of RH, although the statistical difference was not significant.2Zheng J. Cai J. Tao L. Kirih M.A. Shen Z. Xu J. et al.Comparison on the efficacy and prognosis of different strategies for intrahepatic recurrent hepatocellular carcinoma: a systematic review and Bayesian network meta-analysis.Int J Surg. 2020; 83: 196-204https://doi.org/10.1016/j.ijsu.2020.09.031Crossref PubMed Scopus (19) Google Scholar Last year, two updated meta-analyses carried out a specific comparison between RH and RFA.3Liu J. Zhao J. Gu H.A.O. Zhu Z. Repeat hepatic resection VS radiofrequency ablation for the treatment of recurrent hepatocellular carcinoma: an updated meta-analysis.Minim Invasive Ther Allied Technol. 2020 Nov 4; : 1-10https://doi.org/10.1080/13645706.2020.1839775Crossref Scopus (7) Google Scholar,4Yang Y. Yu H. Tan X. You Y. Liu F. Zhao T. et al.Liver resection versus radiofrequency ablation for recurrent hepatocellular carcinoma: a systematic review and meta-analysis.Int J Hyperther. 2021; 38: 875-886https://doi.org/10.1080/02656736.2021.1933218Crossref PubMed Scopus (12) Google Scholar Liu et al. recorded no difference between RH and RFA, as concerned 1-year OS, while RH turned out better than RFA for 3- and 5-year OS, thus showing that long-term prognosis of RH is better than that of RFA.3Liu J. Zhao J. Gu H.A.O. Zhu Z. Repeat hepatic resection VS radiofrequency ablation for the treatment of recurrent hepatocellular carcinoma: an updated meta-analysis.Minim Invasive Ther Allied Technol. 2020 Nov 4; : 1-10https://doi.org/10.1080/13645706.2020.1839775Crossref Scopus (7) Google Scholar Moreover, they showed that RH was higher than RFA, as concerned 1-, 3- and 5-year DFS, and this could be due to the higher local recurrence rate of RFA.3Liu J. Zhao J. Gu H.A.O. Zhu Z. Repeat hepatic resection VS radiofrequency ablation for the treatment of recurrent hepatocellular carcinoma: an updated meta-analysis.Minim Invasive Ther Allied Technol. 2020 Nov 4; : 1-10https://doi.org/10.1080/13645706.2020.1839775Crossref Scopus (7) Google Scholar Same results were recorded in the 3- and 5-year DFS by a subgroup study which met Milan criteria.3Liu J. Zhao J. Gu H.A.O. Zhu Z. Repeat hepatic resection VS radiofrequency ablation for the treatment of recurrent hepatocellular carcinoma: an updated meta-analysis.Minim Invasive Ther Allied Technol. 2020 Nov 4; : 1-10https://doi.org/10.1080/13645706.2020.1839775Crossref Scopus (7) Google Scholar Likewise, Yang et al.'s meta-analysis identified no difference between RH and RFA in 1- and 5-year OS, while RH turned out better than RFA in 2-, 3- and 4-year OS.4Yang Y. Yu H. Tan X. You Y. Liu F. Zhao T. et al.Liver resection versus radiofrequency ablation for recurrent hepatocellular carcinoma: a systematic review and meta-analysis.Int J Hyperther. 2021; 38: 875-886https://doi.org/10.1080/02656736.2021.1933218Crossref PubMed Scopus (12) Google Scholar Moreover, they recorded no difference between RH and RFA, as concerned 1-year DFS, while RH was better than RFA related to 2-, 3-, 4- and 5-year DFS.4Yang Y. Yu H. Tan X. You Y. Liu F. Zhao T. et al.Liver resection versus radiofrequency ablation for recurrent hepatocellular carcinoma: a systematic review and meta-analysis.Int J Hyperther. 2021; 38: 875-886https://doi.org/10.1080/02656736.2021.1933218Crossref PubMed Scopus (12) Google Scholar In addition, RFA efficacy was similar to that of RH for patients with recurrent <3 cm HCC tumors or patients affected by 3 or fewer recurrent nodules.4Yang Y. Yu H. Tan X. You Y. Liu F. Zhao T. et al.Liver resection versus radiofrequency ablation for recurrent hepatocellular carcinoma: a systematic review and meta-analysis.Int J Hyperther. 2021; 38: 875-886https://doi.org/10.1080/02656736.2021.1933218Crossref PubMed Scopus (12) Google Scholar At present and in the presence of shortage of organs that would make SLT the best solution, RFA and RH are two most widely adopted methods. The algorithms suggested by Wen et al. and Tampaki et al. seem to be effective.5Wen T. Jin C. Facciorusso A. Donadon M. Han H.S. Mao Y. et al.MDT of West China Hospital∗. Multidisciplinary management of recurrent and metastatic hepatocellular carcinoma after resection: an international expert consensus.Hepatobiliary Surg Nutr. 2018; 7: 353-371https://doi.org/10.21037/hbsn.2018.08.01Crossref PubMed Google Scholar,6Tampaki M. Papatheodoridis G.V. Cholongitas E. Intrahepatic recurrence of hepatocellular carcinoma after resection: an update.Clin J Gastroenterol. 2021; 14: 699-713https://doi.org/10.1007/s12328-021-01394-7Crossref PubMed Scopus (23) Google Scholar However, further randomized studies, possibly multicentre ones, are strongly required in order to better define the real prognostic value of the two approaches and achieve an accurate definition of the application subgroups. Not applicable. Not applicable. ZiM designed the study, analysed data, wrote the manuscript and drafted paper; SF, PA, AS and ZaM analysed data. All authors read and approved the final manuscript. We thank Dr. Daniela Masi (Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy) for support in English editing." @default.
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• W4200505964 title "Surgical resection versus radiofrequency ablation for the curative treatment of intrahepatic recurrent hepatocellular carcinoma: an unsolved question" @default.
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