In an excellent review of locoregional treatments for hepatocel-lular carcinoma (HCC), Lencioni1 states that there are no unequivocal data backing up radiofrequency ablation (RFA) as a replacement for hepatic resection as a first-line treatment for patients with early-stage HCC because optimal randomized controlled trials are lacking and a subset of HCCs that have a subcapsular location or are adjacent to the gallbladder or a large vessel are not candidates for RFA. Another advantage of hepatic resection over RFA that is not mentioned in the article is the pathological information obtained at resection, from which we learn about the presence or absence of established risk factors for recurrence, such as microscopic vascular invasion and satellite metastases.2 A proportion of clinically early HCCs have pathologically progressed. Patients with such tumors would benefit from adjuvant therapy after surgical resection or RFA because late recurrence, which can be defined as tumor relapse detected 24 months or more after the initial tumor ablation, is likely due to multicentric occurrence rather than local treatment failure. A randomized controlled trial was stopped prematurely because of significant advantages with respect to both overall survival and disease-free survival in patients who received an intra-arterial injection of radioactive 31I-labeled lipiodol after surgical resection.
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