Surgical resection improves survival and reduces recurrence compared to radiofrequency ablation for small hepatocellular carcinoma

This systematic review and meta-analysis investigated the comparative efficacy of surgical resection (SR) versus radiofrequency ablation (RFA) for patients with single hepatocellular carcinoma (HCC) measuring 2 cm or less. The analysis pooled data from studies involving a total sample size of 3,551 patients. The setting of the included studies was not reported in the source data. The primary outcomes assessed included overall survival (OS), recurrence-free survival (RFS), rates of recurrence, morbidity, and mortality. The median follow-up duration for the pooled data was 12.0 months. The study design is a meta-analysis, though the specific study phase was not reported in the available evidence.

Regarding the intervention and comparator, the analysis focused on SR as the active intervention compared against RFA. Specific dosing or protocol details for RFA were not provided in the input data. The primary outcome results revealed distinct differences between the two modalities at various time points. For 1-year overall survival, no statistically significant difference was observed between SR and RFA, with a hazard ratio (HR) of 1.30 and a 95% confidence interval (CI) of 0.56-3.02 (p = 0.54). However, at 3 years, overall survival was significantly greater after SR than after RFA, with an HR of 2.28 (95% CI: 1.38-3.75, p = 0.001). By 5 years, overall survival remained significantly greater after SR, with an HR of 1.66 (95% CI: 1.29-2.15, p = 0.0001).

Recurrence-free survival also favored surgical resection across all measured intervals. At 1 year, RFS was greater after SR than after RFA (HR: 2.21, 95% CI: 1.31-3.72, p = 0.003). This benefit persisted at 3 years (HR: 2.07, 95% CI: 1.50-2.85, p < 0.001) and 5 years (HR: 1.66, 95% CI: 1.29-2.15, p < 0.001). Furthermore, the 5-year recurrence rate was higher after RFA than after SR, with an HR of 1.58 (95% CI: 1.13-2.21, p = 0.008). No specific secondary outcomes with numerical data were reported in the input provided.

Safety and tolerability findings were limited by the available data. Insufficient data were available to measure the postoperative outcomes, and serious adverse events were not reported. Consequently, a direct comparison of morbidity and mortality rates between the two groups could not be established from the provided evidence. This lack of safety data represents a significant limitation when interpreting the survival benefits of SR.

When comparing these results to prior landmark studies in the therapeutic area of early-stage HCC, the findings align with the general consensus that SR offers superior long-term survival for selected patients, although RFA is often preferred for patients with significant comorbidities or poor liver function where surgery is contraindicated. The hazard ratios observed here suggest a substantial long-term advantage for surgery, particularly evident at the 3- and 5-year marks. However, the absence of comparative safety data prevents a definitive conclusion regarding the risk-benefit profile in a broader clinical context.

Key methodological limitations include the lack of reported setting details and the insufficient data regarding postoperative outcomes and serious adverse events. These gaps hinder the ability to assess the full clinical utility of SR versus RFA. Potential biases inherent in meta-analyses of observational or heterogeneous surgical data may also influence the pooled estimates. The study phase was not reported, which limits the ability to contextualize the findings within the broader drug or device development timeline.

The clinical implications of these results suggest that for patients with single HCC ≤ 2 cm who are candidates for surgery, SR may offer superior long-term survival and lower recurrence rates compared to RFA. However, the decision to proceed with surgery must be balanced against the unknown safety profile derived from this specific meta-analysis. Questions remain unanswered regarding the specific nature of postoperative complications and the long-term morbidity associated with each procedure. Clinicians must consider that while survival data favors SR, the lack of safety reporting means the overall benefit is currently uncertain without further data on adverse events.