Abstract
OBJECTIVES: This meta-analysis aims to compare the safety and efficacy of radiofrequency ablation (RFA) and surgical resection (SR) in patients with small hepatocellular carcinoma (HCC). METHODS: A systematic literature search was conducted across four databases (PubMed, Web of Science, Cochrane Library, and Embase) for studies published between January 2020 and June 2024. The included studies reported comparative outcomes of SR and RFA in patients with small HCC (≤ 3 cm), including survival, oncological, and perioperative endpoints. RESULTS: A total of 25 studies involving 10,322 patients were included in the analysis. Compared with RFA, SR was associated with superior survival outcomes, including three-year overall survival (OS) (HR: 0.73; 95% CI: 0.66-0.80), five-year OS (HR: 0.70; 95% CI: 0.62-0.79), one-year recurrence-free survival (RFS) (HR: 0.55; 95% CI: 0.47-0.65), three-year RFS (HR: 0.66; 95% CI: 0.59-0.73), and five-year RFS (HR: 0.76; 95% CI: 0.68-0.85). Although SR was linked to longer operative times, prolonged hospitalization, and higher complication rates, it provided significantly better local tumor control, as reflected by a markedly reduced local recurrence rate. In patients with multiple tumors or those measuring ≤ 2 cm, the three- and five-year RFS rates were comparable between the SR and RFA groups. The three-year OS was also similar between the two treatments for tumors ≤ 2 cm. CONCLUSION: These findings indicate that, compared with RFA, SR offers improved survival and lower recurrence rates in patients with small HCC. However, for individuals with tumors ≤ 2 cm or multiple HCC lesions, long-term survival outcomes are comparable between the two modalities, suggesting that treatment decisions should be individualized on the basis of tumor characteristics and patient risk-benefit profiles.