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Prospective cohort trial to confirm the efficacy of no‐touch radio frequency ablation
Author(s) -
Hirooka Masashi,
Hiraoka Atsushi,
Ochi Hironori,
Koizumi Yohei,
Michitaka Kojiro,
Joko Kouji,
Abe Masanori,
Hiasa Yoichi
Publication year - 2019
Publication title -
journal of gastroenterology and hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.214
H-Index - 130
eISSN - 1440-1746
pISSN - 0815-9319
DOI - 10.1111/jgh.14476
Subject(s) - medicine , hazard ratio , ablation , prospective cohort study , confidence interval , clinical endpoint , cohort , surgery , proportional hazards model , survival rate , progression free survival , overall survival , randomized controlled trial
Background and Aim The aim of the present prospective study was to evaluate tumor recurrence (intrasubsegmental recurrence‐free survival and local tumor recurrence‐free survival) and hepatic functional reserve following no‐touch ablation. Methods The prospective cohort study protocols were approved by the institutional ethics committee. All patients provided written, informed consent. Between January 2014 and September 2016, 231 patients with 277 hepatocellular carcinoma nodules were prospectively enrolled. An internally cooled bipolar electrode was used for no‐touch ablation, while a monopolar electrode was used for direct puncture ablation. The intrasubsegmental recurrence‐free survival rate was the primary end‐point. The secondary outcomes were the local recurrence‐free survival rate, the disease‐free survival rate, and the changes in the Child–Pugh score. Results No‐touch ablation resulted in significantly higher cumulative intrasubsegmental tumor recurrence‐free survival rates than direct puncture ablation (98.0% vs 87.1% at 1 year, 96.9% vs 76.8% at 2 years, and 91.0% vs 68.3% at 3 years, P < 0.001). The no‐touch group also showed significantly better local recurrence‐free survival and disease‐free survival. Even when only primary cases were analyzed, the same results were obtained. To adjust for differences in the background characteristics, inverse probability of treatment weighting adjustment was performed. Only intrasubsegmental tumor recurrence‐free survival was significantly better in the no‐touch group (hazard ratio [HR], 0.08; 95% confidence interval [CI], 0.02–0.20, P < 0.001); there was no difference in local tumor recurrence‐free survival (HR, 0.36; 95% CI, 0.10–1.02, P = 0.071). Conclusions No‐touch ablation appears to be an ideal method for the prevention of intrahepatic dissemination.