Lei ZL, Tan ZL, Luo YH, Yang M, Wang JL, Qin Z, Liu YY. Comparison of the efficacy of laparoscopic hepatectomy and radiofrequency ablation for small hepatocellular carcinoma: A retrospective study. World J Gastroenterol 2025; 31(45): 111540 [DOI: 10.3748/wjg.v31.i45.111540]
Corresponding Author of This Article
Yan-Yao Liu, Department of Hepatobiliary Surgery, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuanjiagang, Yuzhong District, Chongqing 400016, China. liuyanyao@hospital.cqmu.edu.cn
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Oncology
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Retrospective Study
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Dec 7, 2025 (publication date) through Dec 6, 2025
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World Journal of Gastroenterology
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1007-9327
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Lei ZL, Tan ZL, Luo YH, Yang M, Wang JL, Qin Z, Liu YY. Comparison of the efficacy of laparoscopic hepatectomy and radiofrequency ablation for small hepatocellular carcinoma: A retrospective study. World J Gastroenterol 2025; 31(45): 111540 [DOI: 10.3748/wjg.v31.i45.111540]
World J Gastroenterol. Dec 7, 2025; 31(45): 111540 Published online Dec 7, 2025. doi: 10.3748/wjg.v31.i45.111540
Comparison of the efficacy of laparoscopic hepatectomy and radiofrequency ablation for small hepatocellular carcinoma: A retrospective study
Zi-Lun Lei, Zheng-Li Tan, Yun-Hai Luo, Ming Yang, Jin-Lin Wang, Zheng Qin, Yan-Yao Liu
Zi-Lun Lei, Zheng-Li Tan, Yun-Hai Luo, Ming Yang, Jin-Lin Wang, Yan-Yao Liu, Department of Hepatobiliary Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
Zheng Qin, Department of Vascular Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
Co-first authors: Zi-Lun Lei and Zheng-Li Tan.
Co-corresponding authors: Zheng Qin and Yan-Yao Liu.
Author contributions: Lei ZL and Tan ZL contributed equally as co-first authors; Qin Z and Liu YY contributed equally as co-corresponding authors; Lei ZL, Tan ZL, Qin Z, and Liu YY involved in the design of the study, the acquisition and analysis of the data from the experiments, the writing of the manuscript, and conducted a number of collations and statistical analyses; Luo YH, Yang M, and Wang JL designed the experiment and conducted the clinical data collection, performed the postoperative follow-up and recorded the data; all the authors read and approved the final manuscript.
Institutional review board statement: The protocol of this retrospective study was reviewed and approved by the Institutional Review Board of the First Affiliated Hospital of Chongqing Medical University.
Informed consent statement: Given the retrospective design of the study and the use of anonymized data, informed consent was not required.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: All data generated or analyzed during this study are included in this published article.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Yan-Yao Liu, Department of Hepatobiliary Surgery, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuanjiagang, Yuzhong District, Chongqing 400016, China. liuyanyao@hospital.cqmu.edu.cn
Received: August 6, 2025 Revised: September 17, 2025 Accepted: October 28, 2025 Published online: December 7, 2025 Processing time: 119 Days and 1.2 Hours
Abstract
BACKGROUND
Optimal treatment strategies for small hepatocellular carcinoma (HCC) remain under investigation. Laparoscopic hepatectomy (LH) and radiofrequency ablation (RFA) are key curative modalities.
AIM
To compare the long-term survival and perioperative outcomes of LH and RFA for small HCC.
METHODS
In this retrospective study, 254 patients with small HCC who were admitted to the First Affiliated Hospital of Chongqing Medical University between December 2022 and March 2025 were analyzed. Patients were divided into LH (n = 109) and RFA (n = 145) groups based on their treatment modality. Primary endpoints were 36-month overall survival (OS) and disease-free survival (DFS). Secondary endpoints included recurrence rate, perioperative outcomes, and complications. Assessments were conducted at baseline, immediately post-treatment, and at regular follow-up intervals up to 36 months.
RESULTS
Baseline demographic and clinical characteristics, except mean tumor size (LH: 3.05 ± 1.12 cm vs RFA: 2.48 ± 0.93 cm, P < 0.001) and platelet count (higher in LH, P = 0.008), were comparable between groups. LH was associated with longer operative time, greater blood loss, prolonged recovery, higher costs, and increased complication rates (62.39% vs 15.87% for RFA, P < 0.001). However, at 36 months, OS (85.32% vs 66.21%, P < 0.001) and DFS (64.22% vs 44.83%, P = 0.002) were significantly higher in the LH group. Multivariate Cox regression identified surgical approach (LH), lower tumor size, and lower platelet count as independent predictors for improved DFS; only LH independently improved OS (hazard ratio = 0.55; 95% confidence interval: 0.38-0.79; P < 0.001).
CONCLUSION
LH, though associated with increased perioperative morbidity, provides superior long-term survival outcomes compared with RFA in patients with small HCC. Surgical approach should be considered when selecting optimal therapy for this patient population.
Core Tip: This study demonstrates that for patients with small hepatocellular carcinoma, laparoscopic hepatectomy (LH) offers significantly better long-term survival compared to radiofrequency ablation, despite a higher risk of short-term complications. LH was associated with higher 3-year overall and disease-free survival rates. The findings suggest that LH should be the preferred curative option for suitable patients with adequate liver function, while radiofrequency ablation remains a valuable less invasive alternative for higher-risk cases.
