Abstract
BACKGROUND: Liver resection and radiofrequency ablation (RFA) are two common treatments for hepatocellular carcinoma (HCC). However, their efficacy and safety remain unclear. We aimed to conduct a systematic review and meta-analysis to compare the effectiveness and safety of these two treatments. METHODS: We searched multiple databases to identify randomized controlled trials (RCTs) that compared liver resection with RFA for the treatment of HCC. The primary outcome was 5-year overall survival rate. The secondary endpoint was the incidence of complications. We used RevMan 5.4 software to calculate the pooled effects and 95% confidence interval (CI). RESULTS: Ten RCTs and 35 cohort studies were included in this meta-analysis. The pooled OR for 5-year overall survival rate favored liver resection (OR = 1.76, 95% CI = 1.19-2.61, P<0.00001). RFA was indicated with less postoperative complications (OR = 3.35, 95% CI = 2.52-4.45, P<0.00001). CONCLUSION: This meta-analysis suggests that liver resection is more effective than RFA in treating HCC with regard to higher 5-year overall survival rate, while the safety of liver resection was concerning. We recommend liver resection as a first-line treatment for HCC, but RFA may be a preferable choice for patients who are not suitable for surgical procedures. More high-quality RCTs are needed to confirm these findings. SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/prospero/, identifier CRD42025458621.