ABSTRACT
Hepatocellular carcinoma [HCC] is common in Egypt due to the high prevalence of HCV infection and the intermediate prevalence of HBV infection. There is no unequivocal evidence to establish the first line treatment in patients with HCC and compensated cirrhosis and thus studies comparing the different options are needed. Is to compare the effectiveness of percutaneous ablation [PEI, RFA] versus hepatic resection in treatment of HCC patients. This study included 45 HCC patients subjected to medical history, clinical assessment and complete investigations. They were distributed randomly between 3 lines of therapy; Group [1]: 14 patients who underwent RFA, Group [2]: 15 patients who underwent PEI and Group [3]: 16 patients who underwent surgery. Follow up was done for 12 months. The mean age of the patients was 53.19 +/- 4.08 years, 34 [75.6%] were males and 11 [24.4%] were females. All patients came from slum or rural areas in Egypt with low socioeconomic status and 85.1% were smokers. Thirty six [80%] were HCV Ab positive, 5 [11.11%] HBs Ag positive and 4 [8.89%] negative for both markers. Rectal biopsy for Bilharzial ova was positive in 20 [44.44%] patients; 57.6% had cirrhosis, 29.2% had chronic hepatitis and 13.2% had normal liver parenchyma. The tumor was a solitary nodule in 41 [091.11%] patients, two or three nodules in 2 [4.45%] patients. A tumor with a diameter <3cms was found in 28 [62.2%] patients and between 3 and 5cm in 17 [37.8%] patients. The tumor was located in the right lobe in 33 [73.3%] patients and in the left lobe in 12 [26.7%] patients. Child's class A was found in 41 [90.9%] patients and 4 [9.1%] were Child's class B. The response rate between the three modalities of therapy [resection, RF or PEI] showed no statistical significance. There were minimal changes of liver function tests with no statistically significant difference between pre and post percutaneous ablation therapy [PEI, RFA]. The deterioration of liver function [increase in liver transaminases and decrease of serum albumin] and complications were statistically significantly higher in the surgically managed group compared to PEI and RFA groups. PEI showed lower complications than RFA or surgery. Both percutaneous ablation and surgical resection did not significantly differ in terms of efficacy, however, percutaneous ablation therapy showed no mortality and low rate of complications. The choice between either forms of percutaneous ablation should be individualized to every case according to the cost, tumor site and the availability of the therapeutic modality. Surgical resection should not he chosen as a therapy for HCC unless functional hepatic reserve allows it. More studies on large number of cases and follow up for at least five years are needed