Minimally invasive hepatectomy vs. thermoablation for single small (≤3 cm) hepatocellular carcinoma: A weighted real-life national comparison

Felice Giuliante; Simone Famularo; Sara Grasselli; Angelo Sangiovanni; Alessandro Vitale; Giuseppe Cabibbo; Andrea Lauterio; Federica Cipriani; Alice Saccomandi; Marco Arru; Elisa Pinto; Maurizia Rossana Brunetto; Maria Stella Franzè; Camilla Graziosi; Claudia Campani; Fabio Marra; Mariella Di Marco; Mariarosaria Marseglia; Valentina Santi; Mario Capasso; Alberto Masotto; Andrea Fontana; Maurizio Iaria; Alba Rocco; Matteo Serenari; Andrea Mega; Antonio Gasbarrini; Maria Corina Plaz Torres; Mattia Garancini; Simone Conci; Elton Dajti; Pasquale Perri; Rodolfo Sacco; Mariano Giglio; Cecilia Ferari; Michela De Angelis; Albert Troci; Donatella Magalotti; Daniele Nicolini; Giuseppe Zimmitti; Paola Germani; Laura Schiadà; Maria Conticchio; Matteo Zanello; Maurizio Romano; Flavio Milana; Quirino Lai; Stefan Patauner; Antonio Frena; Massimo Rossi; HE.RC.O.LE.S. and the ITA.LI.CA. groups

doi:10.1016/j.jhepr.2025.101420

Minimally invasive hepatectomy vs. thermoablation for single small (≤3 cm) hepatocellular carcinoma: A weighted real-life national comparison

Felice Giuliante, Simone Famularo, Sara Grasselli, Angelo Sangiovanni, Alessandro Vitale, Giuseppe Cabibbo, Andrea Lauterio, Federica Cipriani, Alice Saccomandi, Marco Arru, Elisa Pinto, Maurizia Rossana Brunetto, Maria Stella Franzè, Camilla Graziosi, Claudia Campani, Fabio Marra, Mariella Di Marco, Mariarosaria Marseglia, Valentina Santi, Mario CapassoAlberto Masotto, Andrea Fontana, Maurizio Iaria, Alba Rocco, Matteo Serenari, Andrea Mega, Antonio Gasbarrini, Maria Corina Plaz Torres, Mattia Garancini, Simone Conci, Elton Dajti, Pasquale Perri, Rodolfo Sacco, Mariano Giglio, Cecilia Ferari, Michela De Angelis, Albert Troci, Donatella Magalotti, Daniele Nicolini, Giuseppe Zimmitti, Paola Germani, Laura Schiadà, Maria Conticchio, Matteo Zanello, Maurizio Romano, Flavio Milana, Quirino Lai, Stefan Patauner, Antonio Frena, Massimo Rossi, HE.RC.O.LE.S. and the ITA.LI.CA. groups

Krankenhaus Bozen

Research output: Contribution to journal › Original Article › peer-review

Abstract

Background & Aims: For patients with single small (<-3 cm) hepatocellular carcinoma ablation is the first-line treatment, although a high rate of recurrence has been reported. The aim was to compare videolaparoscopic liver resection (laparoscopic resection group) vs. percutaneous thermoablation (ablation group) in terms of overall survival, recurrence-free survival and early recurrence in a real-life national scenario.Methods: The study is a retrospective collection with subsequent survival analysis. Data were collected from two Italian HCC registries, ITA.LI.CA and HE.RC.O.LE.S. An inverse probability of treatment weighting analysis was performed to balance baseline differences between groups. The Kaplan-Meier method and double-robust Cox multivariable regression were run to estimate the survival and the risk of mortality and recurrence.Results: Between 2008 and 2022, 1,465 patients were enrolled. The laparoscopic resection group and ablation group consisted of 496 and 969 patients, respectively. At baseline, the ablation group had more advanced liver disease, with higher rates of cirrhosis (90.7% vs. 77.3%, p <0.001) and Child-Pugh B status (18.4% vs. 8.8%, p <0.001). After a median follow-up of 59 months and after weighting median overall survival was 60 months (95% CI 52-66) for the ablation group and 93 months (95% CI 75-110) for the laparoscopic resection group (hazard ratio [HR] 0.607, 95% CI 0.533-0.691, p <0.001). Median recurrence-free survival was 26 months (95% CI 23-29) for the ablation group and 39 months (95% CI 30-55) for the laparoscopic resection group (HR 0.736, 95% CI 0.659-0.822, p = 0.0013). Laparoscopy was associated with a reduced risk of early recurrence (HR 0.747, 95% CI 0.655-0.853, p = 0.011).Conclusions: This study provides real-world evidence that for patients with single <= 3 cm HCC, videolaparoscopic liver resection offers superior long-term oncological outcomes compared with thermoablation. These findings support the preference for surgical treatment in this patient population.(c) 2025 The Author(s). Published by Elsevier B.V. on behalf of European Association for the Study of the Liver (EASL). This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Original language	English
Article number	101420
Pages (from-to)	101420
Number of pages	12
Journal	JHEP reports : innovation in hepatology
Volume	7
Issue number	8
DOIs	https://doi.org/10.1016/j.jhepr.2025.101420
Publication status	Published - Apr 2025

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Giuliante, F., Famularo, S., Grasselli, S., Sangiovanni, A., Vitale, A., Cabibbo, G., Lauterio, A., Cipriani, F., Saccomandi, A., Arru, M., Pinto, E., Brunetto, M. R., Franzè, M. S., Graziosi, C., Campani, C., Marra, F., Di Marco, M., Marseglia, M., Santi, V., ... HE.RC.O.LE.S. and the ITA.LI.CA. groups (2025). Minimally invasive hepatectomy vs. thermoablation for single small (≤3 cm) hepatocellular carcinoma: A weighted real-life national comparison. JHEP reports : innovation in hepatology, 7(8), 101420. Article 101420. https://doi.org/10.1016/j.jhepr.2025.101420

@article{569f312f883c411e9a55847e7affc4c5,

title = "Minimally invasive hepatectomy vs. thermoablation for single small (≤3 cm) hepatocellular carcinoma: A weighted real-life national comparison",

abstract = "Background \& Aims: For patients with single small (<-3 cm) hepatocellular carcinoma ablation is the first-line treatment, although a high rate of recurrence has been reported. The aim was to compare videolaparoscopic liver resection (laparoscopic resection group) vs. percutaneous thermoablation (ablation group) in terms of overall survival, recurrence-free survival and early recurrence in a real-life national scenario.Methods: The study is a retrospective collection with subsequent survival analysis. Data were collected from two Italian HCC registries, ITA.LI.CA and HE.RC.O.LE.S. An inverse probability of treatment weighting analysis was performed to balance baseline differences between groups. The Kaplan-Meier method and double-robust Cox multivariable regression were run to estimate the survival and the risk of mortality and recurrence.Results: Between 2008 and 2022, 1,465 patients were enrolled. The laparoscopic resection group and ablation group consisted of 496 and 969 patients, respectively. At baseline, the ablation group had more advanced liver disease, with higher rates of cirrhosis (90.7\% vs. 77.3\%, p <0.001) and Child-Pugh B status (18.4\% vs. 8.8\%, p <0.001). After a median follow-up of 59 months and after weighting median overall survival was 60 months (95\% CI 52-66) for the ablation group and 93 months (95\% CI 75-110) for the laparoscopic resection group (hazard ratio [HR] 0.607, 95\% CI 0.533-0.691, p <0.001). Median recurrence-free survival was 26 months (95\% CI 23-29) for the ablation group and 39 months (95\% CI 30-55) for the laparoscopic resection group (HR 0.736, 95\% CI 0.659-0.822, p = 0.0013). Laparoscopy was associated with a reduced risk of early recurrence (HR 0.747, 95\% CI 0.655-0.853, p = 0.011).Conclusions: This study provides real-world evidence that for patients with single <= 3 cm HCC, videolaparoscopic liver resection offers superior long-term oncological outcomes compared with thermoablation. These findings support the preference for surgical treatment in this patient population.(c) 2025 The Author(s). Published by Elsevier B.V. on behalf of European Association for the Study of the Liver (EASL). This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).",

author = "Felice Giuliante and Simone Famularo and Sara Grasselli and Angelo Sangiovanni and Alessandro Vitale and Giuseppe Cabibbo and Andrea Lauterio and Federica Cipriani and Alice Saccomandi and Marco Arru and Elisa Pinto and Brunetto, \{Maurizia Rossana\} and Franz{\`e}, \{Maria Stella\} and Camilla Graziosi and Claudia Campani and Fabio Marra and \{Di Marco\}, Mariella and Mariarosaria Marseglia and Valentina Santi and Mario Capasso and Alberto Masotto and Andrea Fontana and Maurizio Iaria and Alba Rocco and Matteo Serenari and Andrea Mega and Antonio Gasbarrini and \{Plaz Torres\}, \{Maria Corina\} and Mattia Garancini and Simone Conci and Elton Dajti and Pasquale Perri and Rodolfo Sacco and Mariano Giglio and Cecilia Ferari and \{De Angelis\}, Michela and Albert Troci and Donatella Magalotti and Daniele Nicolini and Giuseppe Zimmitti and Paola Germani and Laura Schiad{\`a} and Maria Conticchio and Matteo Zanello and Maurizio Romano and Flavio Milana and Quirino Lai and Stefan Patauner and Antonio Frena and Massimo Rossi and \{HE.RC.O.LE.S. and the ITA.LI.CA. groups\}",

note = "Lehr-KH Bolzano Regional Hospital, Bolzano, Italy",

year = "2025",

month = apr,

doi = "10.1016/j.jhepr.2025.101420",

language = "English",

volume = "7",

pages = "101420",

journal = "JHEP reports : innovation in hepatology",

issn = "2589-5559",

number = "8",

}

Giuliante, F, Famularo, S, Grasselli, S, Sangiovanni, A, Vitale, A, Cabibbo, G, Lauterio, A, Cipriani, F, Saccomandi, A, Arru, M, Pinto, E, Brunetto, MR, Franzè, MS, Graziosi, C, Campani, C, Marra, F, Di Marco, M, Marseglia, M, Santi, V, Capasso, M, Masotto, A, Fontana, A, Iaria, M, Rocco, A, Serenari, M, Mega, A, Gasbarrini, A, Plaz Torres, MC, Garancini, M, Conci, S, Dajti, E, Perri, P, Sacco, R, Giglio, M, Ferari, C, De Angelis, M, Troci, A, Magalotti, D, Nicolini, D, Zimmitti, G, Germani, P, Schiadà, L, Conticchio, M, Zanello, M, Romano, M, Milana, F, Lai, Q, Patauner, S, Frena, A, Rossi, M & HE.RC.O.LE.S. and the ITA.LI.CA. groups 2025, 'Minimally invasive hepatectomy vs. thermoablation for single small (≤3 cm) hepatocellular carcinoma: A weighted real-life national comparison', JHEP reports : innovation in hepatology, vol. 7, no. 8, 101420, pp. 101420. https://doi.org/10.1016/j.jhepr.2025.101420

Minimally invasive hepatectomy vs. thermoablation for single small (≤3 cm) hepatocellular carcinoma: A weighted real-life national comparison. / Giuliante, Felice; Famularo, Simone; Grasselli, Sara et al.
In: JHEP reports : innovation in hepatology, Vol. 7, No. 8, 101420, 04.2025, p. 101420.

Research output: Contribution to journal › Original Article › peer-review

TY - JOUR

T1 - Minimally invasive hepatectomy vs. thermoablation for single small (≤3 cm) hepatocellular carcinoma

T2 - A weighted real-life national comparison

AU - Giuliante, Felice

AU - Famularo, Simone

AU - Grasselli, Sara

AU - Sangiovanni, Angelo

AU - Vitale, Alessandro

AU - Cabibbo, Giuseppe

AU - Lauterio, Andrea

AU - Cipriani, Federica

AU - Saccomandi, Alice

AU - Arru, Marco

AU - Pinto, Elisa

AU - Brunetto, Maurizia Rossana

AU - Franzè, Maria Stella

AU - Graziosi, Camilla

AU - Campani, Claudia

AU - Marra, Fabio

AU - Di Marco, Mariella

AU - Marseglia, Mariarosaria

AU - Santi, Valentina

AU - Capasso, Mario

AU - Masotto, Alberto

AU - Fontana, Andrea

AU - Iaria, Maurizio

AU - Rocco, Alba

AU - Serenari, Matteo

AU - Mega, Andrea

AU - Gasbarrini, Antonio

AU - Plaz Torres, Maria Corina

AU - Garancini, Mattia

AU - Conci, Simone

AU - Dajti, Elton

AU - Perri, Pasquale

AU - Sacco, Rodolfo

AU - Giglio, Mariano

AU - Ferari, Cecilia

AU - De Angelis, Michela

AU - Troci, Albert

AU - Magalotti, Donatella

AU - Nicolini, Daniele

AU - Zimmitti, Giuseppe

AU - Germani, Paola

AU - Schiadà, Laura

AU - Conticchio, Maria

AU - Zanello, Matteo

AU - Romano, Maurizio

AU - Milana, Flavio

AU - Lai, Quirino

AU - Patauner, Stefan

AU - Frena, Antonio

AU - Rossi, Massimo

AU - HE.RC.O.LE.S. and the ITA.LI.CA. groups

N1 - Lehr-KH Bolzano Regional Hospital, Bolzano, Italy

PY - 2025/4

Y1 - 2025/4

N2 - Background & Aims: For patients with single small (<-3 cm) hepatocellular carcinoma ablation is the first-line treatment, although a high rate of recurrence has been reported. The aim was to compare videolaparoscopic liver resection (laparoscopic resection group) vs. percutaneous thermoablation (ablation group) in terms of overall survival, recurrence-free survival and early recurrence in a real-life national scenario.Methods: The study is a retrospective collection with subsequent survival analysis. Data were collected from two Italian HCC registries, ITA.LI.CA and HE.RC.O.LE.S. An inverse probability of treatment weighting analysis was performed to balance baseline differences between groups. The Kaplan-Meier method and double-robust Cox multivariable regression were run to estimate the survival and the risk of mortality and recurrence.Results: Between 2008 and 2022, 1,465 patients were enrolled. The laparoscopic resection group and ablation group consisted of 496 and 969 patients, respectively. At baseline, the ablation group had more advanced liver disease, with higher rates of cirrhosis (90.7% vs. 77.3%, p <0.001) and Child-Pugh B status (18.4% vs. 8.8%, p <0.001). After a median follow-up of 59 months and after weighting median overall survival was 60 months (95% CI 52-66) for the ablation group and 93 months (95% CI 75-110) for the laparoscopic resection group (hazard ratio [HR] 0.607, 95% CI 0.533-0.691, p <0.001). Median recurrence-free survival was 26 months (95% CI 23-29) for the ablation group and 39 months (95% CI 30-55) for the laparoscopic resection group (HR 0.736, 95% CI 0.659-0.822, p = 0.0013). Laparoscopy was associated with a reduced risk of early recurrence (HR 0.747, 95% CI 0.655-0.853, p = 0.011).Conclusions: This study provides real-world evidence that for patients with single <= 3 cm HCC, videolaparoscopic liver resection offers superior long-term oncological outcomes compared with thermoablation. These findings support the preference for surgical treatment in this patient population.(c) 2025 The Author(s). Published by Elsevier B.V. on behalf of European Association for the Study of the Liver (EASL). This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

AB - Background & Aims: For patients with single small (<-3 cm) hepatocellular carcinoma ablation is the first-line treatment, although a high rate of recurrence has been reported. The aim was to compare videolaparoscopic liver resection (laparoscopic resection group) vs. percutaneous thermoablation (ablation group) in terms of overall survival, recurrence-free survival and early recurrence in a real-life national scenario.Methods: The study is a retrospective collection with subsequent survival analysis. Data were collected from two Italian HCC registries, ITA.LI.CA and HE.RC.O.LE.S. An inverse probability of treatment weighting analysis was performed to balance baseline differences between groups. The Kaplan-Meier method and double-robust Cox multivariable regression were run to estimate the survival and the risk of mortality and recurrence.Results: Between 2008 and 2022, 1,465 patients were enrolled. The laparoscopic resection group and ablation group consisted of 496 and 969 patients, respectively. At baseline, the ablation group had more advanced liver disease, with higher rates of cirrhosis (90.7% vs. 77.3%, p <0.001) and Child-Pugh B status (18.4% vs. 8.8%, p <0.001). After a median follow-up of 59 months and after weighting median overall survival was 60 months (95% CI 52-66) for the ablation group and 93 months (95% CI 75-110) for the laparoscopic resection group (hazard ratio [HR] 0.607, 95% CI 0.533-0.691, p <0.001). Median recurrence-free survival was 26 months (95% CI 23-29) for the ablation group and 39 months (95% CI 30-55) for the laparoscopic resection group (HR 0.736, 95% CI 0.659-0.822, p = 0.0013). Laparoscopy was associated with a reduced risk of early recurrence (HR 0.747, 95% CI 0.655-0.853, p = 0.011).Conclusions: This study provides real-world evidence that for patients with single <= 3 cm HCC, videolaparoscopic liver resection offers superior long-term oncological outcomes compared with thermoablation. These findings support the preference for surgical treatment in this patient population.(c) 2025 The Author(s). Published by Elsevier B.V. on behalf of European Association for the Study of the Liver (EASL). This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

U2 - 10.1016/j.jhepr.2025.101420

DO - 10.1016/j.jhepr.2025.101420

M3 - Original Article

C2 - 40689143

SN - 2589-5559

VL - 7

SP - 101420

JO - JHEP reports : innovation in hepatology

JF - JHEP reports : innovation in hepatology

IS - 8

M1 - 101420

ER -

Minimally invasive hepatectomy vs. thermoablation for single small (≤3 cm) hepatocellular carcinoma: A weighted real-life national comparison

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