05). In contrast, another large retrospective study for GSK-3 phosphorylation HCC patients with tumor less than 5 cm in diameter enrolled in the Liver Cancer Study Group of Japan.[41] The results showed that HCC patients who received liver resection (n = 8010) had better survival than RFA (n = 4037) or TACE (n = 841). In the Japan study, the lesions of HCCs measuring > 3 cm were included in this study resulting incomplete ablation and the proportion

of patients with associated cirrhosis was lower in the surgical resection group than in the nonsurgically treated group. The beneficial effect of hepatectomy was due to the removal of venous tumor thrombi and complete eradication of the primary tumor with clean resection margins.[35, 42] Another similar study from the Hong Kong, China,[19] compared the survival outcome and

disease-free Selleck PR-171 survival of a total of 228 patients who underwent RFA of small (< 3 cm; n = 155) and medium (3.1–5 cm; n = 73) HCC by percutaneous or surgical approach. Percutaneous RFA approach achieved similar tumor control with lower morbidity compared with the surgical approach for patients with small HCC. In our study, during a follow-up of 40 months, there was a trend toward a higher intrahepatic recurrence in the percutaneous RFA group as well as extrahepatic metastases in the surgical hepatectomy group, but the difference was not of statistical significance (P = 0.502 上海皓元 and P = 0.611, respectively). Local recurrences after percutaneous RFA might be attributable to

insufficient ablation of the primary tumor, and/or the presence of portal or hepatic venous tumor thrombi in the adjacent liver.[43] The predominant trend of extrahepatic recurrence in the hepatectomy group was associated with the following factors: compression, separating of the primary tumor, intraoperative blood transfusion, hematogenous dissemination, and/or devascularization.[23, 44] However, RFA had significant advantages over surgical resection in causing only one major and one minor complications, less severe pain, a shorter intensive care unit stay and hospital stays (P < 0.01). These data were similar to the first large clinical experience with RFA as reported by Rossi et al.[45] and other researchers.[36, 46] Two patients underwent liver transplantation further after re-recurrence, and salvage liver transplantation is an efficacious treatment for patients with recurrent HCC and should be considered when repeated hepatic resection is not feasible.[47] There are still a few outstanding issues that are worth pursuing in future studies. First of all, the sample size of 120 patients in this study was relatively small. However, with the strong belief by oncologists and surgeons as well as patients that RFA has become a more commonly used treatment modality for HCC, we believe that a larger sample size will likely be collected for future comparison with surgical resection.