Surgical resection shows superior survival outcomes compared to radiofrequency ablation for small hepatocellular carcinoma cases

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.