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Research Article Treatment options for solitary hepatocellular carcinoma ≤5 cm: Surgery vs Ablation: A multicenter retrospective study
Kazuya Kariyama1orcid , Kazuhiro Nouso1orcid , Atsushi Hiraoka2orcid , Hidenori Toyoda3orcid , Toshifumi Tada4orcid , Kunihiko Tsuji5orcid , Toru Ishikawa6orcid , Takeshi Hatanaka7orcid , Ei Itobayashi8orcid , Koichi Takaguchi9orcid , Akemi Tsutsui9orcid , Atsushi Naganuma10orcid , Satoshi Yasuda3orcid , Satoru Kakizaki11orcid , Akiko Wakuta1orcid , Shohei Shiota1orcid , Masatoshi Kudo12orcid , Takashi Kumada13orcid

DOI: https://doi.org/10.17998/jlc.2023.09.11 [Accepted]
Published online: November 6, 2023
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1Department of Gastroenterology, Okayama City Hospital, 3-20-1, Kitanagase-Omotemachi, Kitaku, Okayama 700-8557 Japan
2Gastroenterology Center, Ehime Prefectural Central Hospital, 83, Kasuga-cho, Matsuyama, Ehime, Japan
3Department of Gastroenterology and Hepatology, Ogaki Municipal Hospital, 4-86, Minami-Cheekcho, Ogaki City, Gifu Prefecture, Japan
4Department of Internal Medicine, Japanese Red Cross Himeji Hospital, 1-12-1, Shimoteno, Himeji, Hyogo, Japan
5Center of Gastroenterology, Teine Keijinkai Hospital, 12-1-40, Maeda 1-jo 12-chome, Teinei-ku, Sapporo, Hokkaido
6Department of Gastroenterology, Saiseikai Niigata Hospital, 280-7 Teraji, Nishi-ku, Niigata City, Niigata Prefecture
7Department of Gastroenterology, Gunma Saiseikai Maebashi Hospital, 564-1, Kamishindacho, Maebashi, Gunma
8Department of Gastroenterology, Asahi General Hospital, 1326, A, Asahi, Chiba, Japan
9Department of Hepatology, Kagawa Prefectural Central Hospital, 1-2-1 Asahi-machi, Takamatsu City, Kagawa Prefecture
10Department of Gastroenterology, National Hospital Organization Takasaki General Medical Center, 36 Takamatsu-cho, Takasaki, Gunma
11Department of Clinical Research, National Hospital Organization Takasaki General Medical Center, 36 Takamatsu-cho, Takasaki, Gunma
12Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka, Japan
13Department of Nursing, Gifu Kyoritsu University, 5-50, Kitagata-cho, Ogaki City, Gifu Prefecture, Japan
Corresponding author:  Kazuhiro Nouso, Tel: 81-86-737-3000, Fax: 81-86-737-3019, 
Email: kazunouso@gmail.com
Received: 5 August 2023   • Revised: 23 August 2023   • Accepted: 11 September 2023
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Abstract

Introduction
The aim of this study was to compare the therapeutic efficacy of ablation and surgery in solitary Hepatocellular carcinoma (HCC) measuring ≤5 cm with a large HCC cohort database.
Methods
The study included consecutive 2067 patients with solitary HCC who were treated with either ablation (N=1248) or surgery (N=819). The patients were divided into three groups based on the tumor size and compared the outcomes of the two therapies using propensity score matching.
Results
No significant difference in recurrence-free survival (RFS) or overall survival (OS) was found between surgery and ablation groups for tumors measuring ≤2 cm or >2 cm but ≤3 cm. For tumors measuring >3 cm but ≤5 cm, RFS was significantly better with surgery than with ablation (3.6 and 2.0 years, respectively, p = 0.0297). However, no significant difference in OS was found between surgery and ablation in this group (6.7 and 6.0 years, respectively, p = 0.668).
Discussion/Conclusion
The study suggests that surgery and ablation can be equally used as a treatment for solitary HCC no more than 3 cm in diameter. For HCCs measuring 3–5 cm, the OS was not different between therapies; thus, ablation and less invasive therapy can be considered a treatment option; however, special caution should be taken to prevent recurrence.

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