Supplementary Material for: Comparative study of laparoscopic hepatectomy, open hepatectomy, and percutaneous radiofrequency ablation for small hepatocellular carcinoma: an ancillary study of the SURF trial

Background: Laparoscopic hepatectomy (LH) for hepatocellular carcinoma (HCC) is increasing. To evaluate the efficacy of LH for small HCC (≤3 tumors within ≤3 cm), we compared short- and long-term outcomes between LH, open hepatectomy (OH), and radiofrequency ablation (RFA) as an ancillary study of the prospective multicenter study “Efficacy of SUrgery vs. Radio Frequency ablation on primary hepatocellular carcinoma” (SURF trial).
Methods: The study population comprised patients enrolled in the SURF trial. Primary endpoints were recurrence-free survival (RFS) and overall survival (OS). Secondary endpoints were short-term outcomes and the relation between tumor conditions and prognosis for each treatment. RFS and OS were adjusted by inverse probability of treatment-weighted analysis.
Results: Of 398 patients included in the study, 38 underwent LH (LH group), 139 underwent OH (OH group), and 221 underwent RFA (RFA group). RFS and OS did not differ significantly between groups. Five-year RFS and OS rates in the LH, OH, and RFA groups were 50%, 41.6%, and 41.8% (p=0.89) and 85.2%, 80.1%, and 80.1% (p=0.83), respectively. Postoperative complication rates (Clavien-Dindo classification ≥III) in the LH, OH, and RFA groups were 22.5%, 23.2%, and 4.2%, respectively (p<0.01). Median postoperative hospital stays in the LH, OH, and RFA groups were 11, 13, and 7 days (p <0.01). OH was selected significantly more frequently than RFA when patients had the following factors: maximum tumor diameter >2 cm (OR=3.13; 95% CI=1.72–5.69), proximity to major vessels (OR=2.08; 95% CI=1.01–4.30), and good liver function (OR=0.46; 95% CI=0.22–0.93). There was no significant difference in prognosis between tumor conditions and each treatment.
Conclusions: Survival rates after LH for early HCC were not significantly different from those of OH and RFA. However, LH is a feasible and effective treatment for early HCC with a wide variety of tumor conditions.