Single HCC smaller than 2 cm: surgery or ablation? Surgeon's perspective

For hepatocellular carcinoma (HCC), surgical resection and radiofrequency ablation (RFA) are accepted as effective treatments. To clarify the long-term outcome in patients with small HCC, we analyzed data from a nationwide survey of Japan. Between 2000 and 2003, a total of 2,550 patients who had undergone resection (n = 1,235) or RFA (n = 1,315) for single small HCC (a parts per thousand currency sign2 cm) were registered to the database of the Liver Cancer Study Group of Japan (LCSGJ). After a median follow-up period of 37 months, disease-free survival after resection was significantly better than after RFA (1-year, 91 vs. 87%; 2-year, 46 vs. 25%; P = 0.001), but overall survival after resection and RFA were similar (98 vs. 99%; 94 vs. 95%, P = 0.28). In the patients of Child-Pugh class A, disease-free survival was significantly better after resection (n = 1,056) than after RFA (n = 965) (P = 0.001), while overall survival was not significantly different (P = 0.16). In the patients of Child-Pugh class B, both disease-free and overall survival were almost similar (P = 0.63 and P = 0.66) after resection (n = 136) and RFA (n = 303). For single small HCC (a parts per thousand currency sign2 cm), surgical resection provides better disease-free survival than does RFA. Longer follow-up is needed to regard this indication as conclusive.