Comparison of the efficacy of laparoscopic hepatectomy and radiofrequency ablation for small hepatocellular carcinoma: A retrospective study

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.

Keywords: Hepatocellular carcinoma; Laparoscopic hepatectomy; Radiofrequency ablation; Survival outcomes; Disease-free survival; Postoperative complications

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.