Laparoscopic or Open Liver Resection Versus Multibipolar Radiofrequency Ablation of HCC Within Milan Criteria on Cirrhosis
Abstract
BACKGROUND & AIMS: We compared multibipolar radiofrequency ablation (mbpRFA) with open liver resection (OLR) or laparoscopic liver resection (LLR) in patients with HCCs within Milan. METHODS: This multicenter cohort study included patients treated by mbpRFA, OLR or LLR for HCC within the Milan Criteria, developed on advanced fibrosis in nine French centres between 2008 and 2018. Adjustments on HCC size/number, gender, age, ASA, HCV, HBV, metabolic syndrome, chronic alcohol intake, MELD score, serum AFP level, APRI score, cirrhosis, significant portal hypertension and HCC localization were performed using multivariable regressions with centre-robust variance and propensity score-based matching (3:1 nearest-neighbour with calliper < 0.1; effective ratios 2.18:1 and 2.43:1). RESULTS: 1040 patients were included (median age: 64 years; male 82.9%), with 606, 266 and 168 treated by mbpRFA, LLR and OLR. Most HCCs were solitary (84.8%) and on cirrhosis (89.2%). In months, the follow-up was 50.2 (95% CI: 45.3, 54.3), 43.3 (95% CI: 40.0, 48.6) and 47.4 (95% CI: 40.8, 58.7) for mbpRFA, LLR and OLR patients. After matching, OLR patients had similar overall survival (OS) (HR = 1.05 [CI 95% = 0.65, 1.69], p = 0.853), transplant-free survival (TFS) (HR = 0.91 [CI 95% = 0.56, 1.47]; p = 0.690) or recurrence-free survival (RFS) (HR = 0.99 [CI 95% = 0.69, 1.43]; p = 0.968) compared to mbpRFA patients but with more severe adverse events (RR = 2.58 [CI 95% = 1.16, 5.71]; p = 0.02) and mortality (RR = 4.51 [CI 95% = 1.16, 17.59]; p = 0.03). After matching, LLR patients had better OS (HR = 0.57 [CI 95% = 0.38, 0.88], p = 0.01) but similar TFS (HR = 0.77 [CI 95% = 0.55, 1.1]; p = 0.152) and more severe adverse events (RR = 2.61 [CI 95% = 1.15, 5.96]; p = 0.022) compared to mbpRFA patients. LLR patients had a better RFS (HR = 0.7 [CI 95% = 0.53, 0.91]; p = 0.009) than mbpRFA patients. When distant-only recurrences were considered in the mbpRFA patients, there was no significant difference in RFS (p = 0.087). The LLR survival benefit was consistent across pre-specified subgroups, with no interaction surviving correction for multiple testing. CONCLUSIONS: Minimally invasive modalities (LLR or mbpRFA) should be prioritized when treating early HCC. LLR maximizes oncological outcomes, but mbpRFA maintains optimal TFS with less morbidity.
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BibTeX
@article{hobeika2026laparoscopic,
title = {{Laparoscopic or Open Liver Resection Versus Multibipolar Radiofrequency Ablation of HCC Within Milan Criteria on Cirrhosis}},
author = {Christian Hobeika and François Cauchy and Agnès Rode and Ephrem Salamé and Olivier Scatton and Lilian Schwarz and Panteleimon Papadopoulos and Arnaud Hocquelet and Anne‐frédérique Manichon and Christophe Aubé and Frederic Oberti and Angelo Della Corte and Alain Luciani and Suzanne Gay and Mickaël Lesurtel and Chetana Lim and Pierre Nahon and Nathalie Ganne-Carrié and Lorraine Blaise and Olivier Soubrane and Olivier Sutter and Raffaele Brustia and Louise Barbier and Alexis Laurent and Olivier Seror and Jean‐charles Nault},
journal = {Liver International},
year = {2026},
month = jul,
doi = {10.1111/liv.70802},
url = {https://hal.science/hal-05840387v1},
note = {CC BY},
}
RIS
TY - JOUR
TI - Laparoscopic or Open Liver Resection Versus Multibipolar Radiofrequency Ablation of HCC Within Milan Criteria on Cirrhosis
AU - Christian Hobeika
AU - François Cauchy
AU - Agnès Rode
AU - Ephrem Salamé
AU - Olivier Scatton
AU - Lilian Schwarz
AU - Panteleimon Papadopoulos
AU - Arnaud Hocquelet
AU - Anne‐frédérique Manichon
AU - Christophe Aubé
AU - Frederic Oberti
AU - Angelo Della Corte
AU - Alain Luciani
AU - Suzanne Gay
AU - Mickaël Lesurtel
AU - Chetana Lim
AU - Pierre Nahon
AU - Nathalie Ganne-Carrié
AU - Lorraine Blaise
AU - Olivier Soubrane
AU - Olivier Sutter
AU - Raffaele Brustia
AU - Louise Barbier
AU - Alexis Laurent
AU - Olivier Seror
AU - Jean‐charles Nault
PY - 2026
DA - 2026/07/20
JO - Liver International
DO - 10.1111/liv.70802
UR - https://hal.science/hal-05840387v1
AB - BACKGROUND & AIMS: We compared multibipolar radiofrequency ablation (mbpRFA) with open liver resection (OLR) or laparoscopic liver resection (LLR) in patients with HCCs within Milan. METHODS: This multicenter cohort study included patients treated by mbpRFA, OLR or LLR for HCC within the Milan Criteria, developed on advanced fibrosis in nine French centres between 2008 and 2018. Adjustments on HCC size/number, gender, age, ASA, HCV, HBV, metabolic syndrome, chronic alcohol intake, MELD score, serum AFP level, APRI score, cirrhosis, significant portal hypertension and HCC localization were performed using multivariable regressions with centre-robust variance and propensity score-based matching (3:1 nearest-neighbour with calliper < 0.1; effective ratios 2.18:1 and 2.43:1). RESULTS: 1040 patients were included (median age: 64 years; male 82.9%), with 606, 266 and 168 treated by mbpRFA, LLR and OLR. Most HCCs were solitary (84.8%) and on cirrhosis (89.2%). In months, the follow-up was 50.2 (95% CI: 45.3, 54.3), 43.3 (95% CI: 40.0, 48.6) and 47.4 (95% CI: 40.8, 58.7) for mbpRFA, LLR and OLR patients. After matching, OLR patients had similar overall survival (OS) (HR = 1.05 [CI 95% = 0.65, 1.69], p = 0.853), transplant-free survival (TFS) (HR = 0.91 [CI 95% = 0.56, 1.47]; p = 0.690) or recurrence-free survival (RFS) (HR = 0.99 [CI 95% = 0.69, 1.43]; p = 0.968) compared to mbpRFA patients but with more severe adverse events (RR = 2.58 [CI 95% = 1.16, 5.71]; p = 0.02) and mortality (RR = 4.51 [CI 95% = 1.16, 17.59]; p = 0.03). After matching, LLR patients had better OS (HR = 0.57 [CI 95% = 0.38, 0.88], p = 0.01) but similar TFS (HR = 0.77 [CI 95% = 0.55, 1.1]; p = 0.152) and more severe adverse events (RR = 2.61 [CI 95% = 1.15, 5.96]; p = 0.022) compared to mbpRFA patients. LLR patients had a better RFS (HR = 0.7 [CI 95% = 0.53, 0.91]; p = 0.009) than mbpRFA patients. When distant-only recurrences were considered in the mbpRFA patients, there was no significant difference in RFS (p = 0.087). The LLR survival benefit was consistent across pre-specified subgroups, with no interaction surviving correction for multiple testing. CONCLUSIONS: Minimally invasive modalities (LLR or mbpRFA) should be prioritized when treating early HCC. LLR maximizes oncological outcomes, but mbpRFA maintains optimal TFS with less morbidity.
SN - 1478-3223
SN - 1478-3231
ER -