1016
G. Huang, X. Chen, W. Y. Lau, F. Shen, R.-Y. Wang, S.-X. Yuan et al.
Commentary
Quality of life after surgical resection compared with radiofrequency ablation for small hepatocellular carcinomas (Br J Surg 2014; 101: 1006–1015) It is difficult to make meaningful comparisons of health-related quality-of-life (HRQL) data between surgery and less invasive treatments in non-randomized studies because patient characteristics associated with intervention choice influence outcomes. This paper compared outcomes between patients undergoing surgery or percutaneous radiofrequency ablation (RFA) for treatment of hepatitis B-related solitary small hepatocellular carcinoma. Treatment selection was made by patients following ‘full communication’ with individual clinicians. Unsurprisingly, HRQL scores were consistently better after less invasive treatment compared with surgery, and surgery had more immediate complications and a longer hospital stay than non-surgical treatment. Local recurrence and survival were similar in the two groups. Although validated generic and disease-specific HRQL measures were used, and good questionnaire compliance at baseline and follow-up achieved, it is unclear how treatment choices were made and what information was exchanged to inform this process. National and international organizations recommend that decisions to undergo surgery are based on shared decision-making during consultations in which patients and professionals understand what information is important to the other person when choosing a treatment1 . Nowadays recording of consultations is easy with widespread access to digital recorders in smartphones. Recording clinical encounters in this way could transform everything. It will allow the content of surgical consultations to be analysed and shed light on how preferences may influence decision-making (and therefore treatment outcome)2 . Understanding treatment selection, however, will not replace robust methods for evaluating healthcare interventions, which require that treatment be allocated by randomization and that outcomes be objective and assessed by blinded personnel. Well designed and conducted randomized clinical trials, therefore, are still needed to establish whether surgery or percutaneous RFA is more effective for the treatment of hepatitis B-related solitary small hepatocellular carcinoma. J. M. Blazeby Level 3, Dolphin House, Bristol Royal Infirmary, Bristol BS2 8HW, UK
(e-mail: [email protected]) DOI: 10.1002/bjs.9572
Disclosure
The author declares no conflict of interest. References 1 Royal College of Surgeons of England. Good Surgical Practice. RCSENG – Professional Standards and Regulation: London, 2008. 2 Elwyn G. ‘Patientgate’ – digital recordings change everything. BMJ 2014; 348: g2078.
© 2014 BJS Society Ltd Published by John Wiley & Sons Ltd
www.bjs.co.uk
BJS 2014; 101: 1016
G. Huang, X. Chen, W. Y. Lau, F. Shen, R.-Y. Wang, S.-X. Yuan et al.
Commentary
Quality of life after surgical resection compared with radiofrequency ablation for small hepatocellular carcinomas (Br J Surg 2014; 101: 1006–1015) It is difficult to make meaningful comparisons of health-related quality-of-life (HRQL) data between surgery and less invasive treatments in non-randomized studies because patient characteristics associated with intervention choice influence outcomes. This paper compared outcomes between patients undergoing surgery or percutaneous radiofrequency ablation (RFA) for treatment of hepatitis B-related solitary small hepatocellular carcinoma. Treatment selection was made by patients following ‘full communication’ with individual clinicians. Unsurprisingly, HRQL scores were consistently better after less invasive treatment compared with surgery, and surgery had more immediate complications and a longer hospital stay than non-surgical treatment. Local recurrence and survival were similar in the two groups. Although validated generic and disease-specific HRQL measures were used, and good questionnaire compliance at baseline and follow-up achieved, it is unclear how treatment choices were made and what information was exchanged to inform this process. National and international organizations recommend that decisions to undergo surgery are based on shared decision-making during consultations in which patients and professionals understand what information is important to the other person when choosing a treatment1 . Nowadays recording of consultations is easy with widespread access to digital recorders in smartphones. Recording clinical encounters in this way could transform everything. It will allow the content of surgical consultations to be analysed and shed light on how preferences may influence decision-making (and therefore treatment outcome)2 . Understanding treatment selection, however, will not replace robust methods for evaluating healthcare interventions, which require that treatment be allocated by randomization and that outcomes be objective and assessed by blinded personnel. Well designed and conducted randomized clinical trials, therefore, are still needed to establish whether surgery or percutaneous RFA is more effective for the treatment of hepatitis B-related solitary small hepatocellular carcinoma. J. M. Blazeby Level 3, Dolphin House, Bristol Royal Infirmary, Bristol BS2 8HW, UK
(e-mail: [email protected]) DOI: 10.1002/bjs.9572
Disclosure
The author declares no conflict of interest. References 1 Royal College of Surgeons of England. Good Surgical Practice. RCSENG – Professional Standards and Regulation: London, 2008. 2 Elwyn G. ‘Patientgate’ – digital recordings change everything. BMJ 2014; 348: g2078.
© 2014 BJS Society Ltd Published by John Wiley & Sons Ltd
www.bjs.co.uk
BJS 2014; 101: 1016
