Liver Resection versus Radiofrequency Ablation for Small Hepatocellular Carcinoma

Abstract

Introduction: For early-stage hepatocellular carcinoma (HCC), both surgical resection and radiofrequency ablation (RFA) are potentially curative. Optimal selection between these modalities remains controversial, particularly in patients with preserved liver function. This review compares long-term oncologic outcomes.

Methods: A systematic review was performed including randomized trials and propensity-score matched studies comparing resection and RFA for solitary HCC ≤ three centimeters. Outcome measures were overall survival, recurrence-free survival, local recurrence rate, and major complications.

Results: Eight randomized trials and twelve high-quality observational studies were included. Resection was associated with superior overall survival and recurrence-free survival in most studies, with risk reductions of twenty to thirty percent. Local recurrence was significantly higher after RFA, ranging from ten to twenty percent versus less than five percent after resection. Major complication rates were lower after RFA, but procedure-related mortality was similar.

Discussion: The survival advantage of resection is partly driven by better local control and elimination of occult satellite nodules. However, for patients with significant portal hypertension or marginal liver reserve, RFA provides acceptable oncologic outcomes with lower morbidity. Tumor location near major vessels or the gallbladder favors resection. Repeated RFA is feasible for recurrences.

Conclusions: Liver resection offers superior long-term survival for small HCC in compensated cirrhosis. RFA remains an effective alternative for high-risk surgical patients or central tumors.