Background: Resection has been the standard of care for patients with solitary hepatocellular carcinoma (HCC). Transarterial embolization and percutaneous ablation are alternative therapies often reserved for suboptimal surgical candidates. Here we compare long-term outcomes of patients with solitary HCC treated with resection versus combined embo-ablation. Methods: We previously reported a retrospective comparison of resection and embo-ablation in 73 patients with solitary HCC <7 cm after a median follow-up of 23 months. This study represents long-term updated follow-up over a median of 134 months. Results: There was no difference in survival among Okuda I patients who underwent resection versus embo-ablation (66 vs 58 months, p =.39). There was no difference between the groups in the rate of distant intrahepatic (p =.35) or metastatic progression (p =.48). Surgical patients experienced more complications (p =.004), longer hospitalizations (p <.001), and were more likely to require hospital readmission within 30 days of discharge (p =.03). Conclusion: Over a median follow up of more than 10 years, we found no significant difference in overall survival of Okuda 1 patients with solitary HCC <7 cm who underwent surgical resection versus embo-ablation. Our data suggest that there may be a greater role for primary embo-ablation in the treatment of potentially resectable solitary HCC.
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