We read with great interest and enthusiasm the AASLD practice guidelines, “Management of Hepatocellular Carcinoma” where the current status of surveillance for hepatocellular carcinoma (HCC) as well as diagnosis, staging, and treatment of patients with HCC was comprehensively reviewed.1 Specific evidence supporting recommendations were provided and areas requiring active research noted. In the treatment section regarding percutaneous ablation, we concurred this is the best treatment option for patients with early stage HCC who are not suitable for resection or transplantation. Nevertheless, the statement that there are no randomized controlled trials (RCT) comparing local ablation to resection may be somewhat misleading and thus needs clarification.
In Taiwan where chronic viral hepatitis and HCC are endemic,2 we have conducted a prospective study to compare tumor recurrence and survival among patients with small HCC after surgical resection or percutaneous ethanol injection therapy.3 In this study, a total of 76 eligible patients were randomly assigned to two groups based on treatment. By using Cox regression model and Kaplan-Meier survival analysis, our results showed no statistical significance for tumor recurrence and a similar survival benefit between the two treatment groups. Although the number of patients in this study is relatively small, our observations clearly imply that percutaneous ethanol injection therapy appears to be as safe and effective as surgical resection, and both treatments can be considered first-line therapeutic options for small HCC. With these encouraging results, further larger prospective randomized controlled studies are awaited to compare other local ablation modalities (radiofrequency, microwave, laser or cryotherapy) with surgical resection for the treatment of small HCC.