Surgical resection shows superior survival outcomes compared to radiofrequency ablation for small hepatocellular carcinoma casesSurgery offers better long-term survival and lower recurrence rates for small liver cancer cases compared to ablation

European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology Published May 2, 2026 Study authors: Viana Eduardo Freitas, Falcão Araújo Diego, Ribeiro Thiago Francischetto, Pinheiro Vaner Paulo da Si… PubMed ↗ DOI ↗ Editorial oversight: Dr. Amelia Tan, PhD · Internal Medicine & Chronic Disease

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Key Takeaway

Surgical resection yields significantly better 3- and 5-year survival and lower recurrence rates than radiofrequency ablation for single HCC lesions ≤2 cm.

This systematic review and meta-analysis evaluated 3,551 patients with single hepatocellular carcinoma lesions measuring 2 centimeters or less. The study compared surgical resection against radiofrequency ablation to determine the best initial treatment strategy for this specific cancer stage. Researchers analyzed overall survival, recurrence-free survival, and rates of recurrence, morbidity, and mortality across the combined dataset.

At one year, no statistically significant difference was observed between the two treatment groups regarding overall survival. However, longer-term data revealed distinct advantages for surgical intervention. By the three-year mark, overall survival was significantly greater after surgical resection compared to radiofrequency ablation, with a hazard ratio of 2.28 and a p-value of 0.001.

Five-year overall survival continued to favor the surgical approach, showing a hazard ratio of 1.66 and a p-value of 0.0001. Recurrence-free survival also demonstrated a clear benefit for surgery at one, three, and five years. Conversely, the five-year recurrence rate was higher after radiofrequency ablation than after surgical resection, with a hazard ratio of 1.58.

Insufficient data were available to measure specific postoperative outcomes or serious adverse events due to the nature of the available literature. Further randomized controlled trials are required to validate these findings and confirm causality. Despite these limitations, surgical resection appears likely associated with better oncological outcomes as a first-line treatment for very-early-stage hepatocellular carcinoma.

This study looked at how surgery compares to radiofrequency ablation for small liver cancers. Researchers examined data from over 3,500 patients who had one of these treatments. The goal was to see which method helped people live longer and stay healthy longer.

At one year, both treatments worked about the same. However, the results changed over time. By the third year, surgery showed much better survival rates. This advantage continued to grow by the fifth year of follow-up.

Patients who had surgery also had fewer chances of the cancer coming back. The risk of recurrence was lower for those who underwent surgery. Ablation had higher rates of the cancer returning within five years.

The study did not have enough information to compare safety details. More research is needed to confirm these results. Surgery seems like a strong first choice for very early stage liver cancer.

What this means for you:

Surgery leads to better survival and fewer cancer returns for small liver tumors compared to ablation, though safety data is missing.

Study Details

Study typeMeta analysis

Sample sizen = 3,551

EvidenceLevel 1

Follow-up12.0 mo

PublishedApr 2026

PMID41690098

View Original Abstract ↓

BACKGROUND: The optimal first-line treatment for single hepatocellular carcinoma (HCC) ≤ 2 cm, radiofrequency ablation (RFA) or surgical resection (SR), remains unclear. We performed a systematic review and meta-analysis to compare oncological outcomes, morbidity, and mortality rates. METHODS: Indexed published studies comparing RFA and SR were systematically searched in the PubMed, Embase, Scopus, and Cochrane Library databases. The outcomes evaluated included overall survival (OS), recurrence-free survival (RFS), and rates of recurrence, morbidity, and mortality. Hazard ratios (HR) and 95% confidence intervals (CI) were used to assess the outcomes. RESULTS: Fourteen studies (3551 patients), one randomized controlled trial (RCT), and 13 retrospective cohorts were included. No statistically significant difference was observed for the 1-year OS (HR: 1.30, CI: 0.56-3.02, p = 0.54). The OS at 3 and 5 years was significantly greater after SR than after RFA (HR: 2.28, CI: 1.38-3.75, p = 0.001; and HR: 1.66, CI: 1.29-2.15, p = 0.0001, respectively). The RFS at 1, 3, and 5 years was also greater after SR than after RFA (HR: 2.21, CI: 1.31-3.72, p = 0.003; HR: 2.07, CI: 1.50-2.85, p < 0.001; and HR: 1.66, CI: 1.29-2.15, p < 0.001, respectively). The 5-year recurrence rate was higher after RFA than after SR (HR: 1.58, CI: 1.13-2.21, p = 0.008). Insufficient data were available to measure the postoperative outcomes. CONCLUSION: As a first-line treatment for very-early-stage HCC, SR is likely associated with better oncological outcomes than RFA. Further RCTs are required to validate this finding.

Surgical resection shows superior survival outcomes compared to radiofrequency ablation for small hepatocellular carcinoma casesSurgery offers better long-term survival and lower recurrence rates for small liver cancer cases compared to ablation

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Surgical resection shows superior survival outcomes compared to radiofrequency ablation for small hepatocellular carcinoma casesSurgery offers better long-term survival and lower recurrence rates for small liver cancer cases compared to ablation

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