Combined radiofrequency ablation and ethanol injection versus repeat hepatectomy for elderly patients with recurrent hepatocellular carcinoma after initial hepatic surgery

<p><b>Purpose:</b> To retrospectively compare the efficacy and safety of combined radiofrequency ablation and percutaneous ethanol injection (RFA–PEI) with repeat hepatectomy for elderly patients with initial recurrent hepatocellular carcinoma (HCC) after hepatic surgery.</p> <p><b>Methods:</b> From January 2009 to June 2015, 105 elderly patients (≥70 years) who underwent RFA–PEI (<i>n</i> = 57) or repeated hepatectomy (<i>n</i> = 48) for recurrent HCC ≤ 5.0 cm were included in the study. The overall survival (OS) and recurrence-free survival (RFS) were analysed with the Kaplan–Meier method and compared by the log-rank test. Non-tumour-related death, complications and hospital stays were assessed. Univariate and multivariate analyses were performed to identify the prognostic significance of the variables in predicting the OS and RFS.</p> <p><b>Results:</b> OS rates were 78.2%, 40.8% and 36.7% at 1, 3 and 5 years after RFA–PEI and 76.3%, 52.5% and 42.6% after repeat hepatectomy, respectively (<i>p</i> = 0.413). Correspondingly, the 1-, 3- and 5-year RFS rates after RFA–PEI and repeat hepatectomy were 69.5%, 37.8%, 33.1% and 73.1%, 49.7%, 40.7%, respectively (<i>p</i> = 0.465). Non-tumour-related deaths in the RFA–PEI group (2/57) were significantly fewer than those in the repeat hepatectomy group (10/48) (<i>p</i> = 0.016). RFA–PEI was superior to repeat hepatectomy regarding the major complication rates and length of in-hospital stay (both <i>p</i> < 0.001). Multivariate analysis showed that the tumour number was the significant prognostic factor for the OS (hazard ratio (HR) = 1.961, 95% CI = 1.043–3.686, <i>p</i> = 0.037) and RFS (HR = 1.866, 95% CI = 1.064–3.274, <i>p</i> = 0.030).</p> <p><b>Conclusion:</b> RFA–PEI provides comparable OS and RFS to repeat hepatectomy for elderly patients with small recurrent HCC after hepatectomy but with fewer non-tumour-related deaths, major complications and shorter hospital stays.</p>