Karagiannakis DS. Letter to the Editor: Does hepatectomy outweigh radiofrequency ablation in the management of small hepatocellular carcinoma? World J Gastroenterol 2026; 32(14): 116380 [DOI: 10.3748/wjg.v32.i14.116380]
Corresponding Author of This Article
Dimitrios S Karagiannakis, Assistant Professor, Fourth Department of Internal Medicine, Academic Hospital “Attikon”, Medical School of the National and Kapodistrian University of Athens, Aghiou Thoma 17, Athens 12462, Greece. dkarag@med.uoa.gr
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Gastroenterology & Hepatology
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Correspondence
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Apr 14, 2026 (publication date) through Apr 3, 2026
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World Journal of Gastroenterology
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1007-9327
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Karagiannakis DS. Letter to the Editor: Does hepatectomy outweigh radiofrequency ablation in the management of small hepatocellular carcinoma? World J Gastroenterol 2026; 32(14): 116380 [DOI: 10.3748/wjg.v32.i14.116380]
World J Gastroenterol. Apr 14, 2026; 32(14): 116380 Published online Apr 14, 2026. doi: 10.3748/wjg.v32.i14.116380
Letter to the Editor: Does hepatectomy outweigh radiofrequency ablation in the management of small hepatocellular carcinoma?
Dimitrios S Karagiannakis
Dimitrios S Karagiannakis, Fourth Department of Internal Medicine, Academic Hospital “Attikon”, Medical School of the National and Kapodistrian University of Athens, Athens 12462, Greece
Author contributions: Karagiannakis DS was responsible for conceptualization, writing review, editing, supervision, resources, and methodology.
Conflict-of-interest statement: Author declares no conflict of interest in publishing the manuscript.
Corresponding author: Dimitrios S Karagiannakis, Assistant Professor, Fourth Department of Internal Medicine, Academic Hospital “Attikon”, Medical School of the National and Kapodistrian University of Athens, Aghiou Thoma 17, Athens 12462, Greece. dkarag@med.uoa.gr
Received: November 10, 2025 Revised: December 30, 2025 Accepted: January 21, 2026 Published online: April 14, 2026 Processing time: 144 Days and 8.5 Hours
Abstract
According to Barcelona Clinic Liver Cancer staging, small hepatocellular carcinoma (HCC) in patients with liver cirrhosis may be treated either by liver resection, radiofrequency ablation (RFA), microwave ablation, or liver transplantation. However, not all small liver carcinomas are the same. Differences in the exact size of the tumor, the number of lesions, and the liver segment where the cancer is located, along with variations in the severity of liver dysfunction, impact the outcomes and survival of patients. In HCC tumors less than 3 cm in size, surgical resection appears to provide better 3-year overall survival and disease-free survival than RFA in specific patient groups. At the same time, RFA is likely associated with fewer postoperative complications and shorter hospital stays, factors that are particularly significant for older or vulnerable patients. Consequently, it is essential to assess which patients are more appropriate candidates for hepatectomy and which should be considered for RFA, taking into account several factors, beyond merely the size of the liver tumor. The study by Lei et al, published in the recent issue of the World Journal of Gastroenterology, aimed to clarify further which treatment, surgical resection or RFA, is more effective for small HCC.
Core Tip: The optimal treatment of patients with liver cirrhosis and early hepatocellular carcinomas who are not suitable candidates for liver transplantation is still a matter of debate. Percutaneous ablation has shown effectiveness for liver tumors smaller than 3 cm, and it typically results in fewer postoperative complications compared to surgical resection. However, surgical resection appears to provide better long-term outcomes, including higher rates of recurrence-free survival and overall survival. Consequently, it should be the preferred approach in tumors larger than 3 cm or those located in areas where satisfactory peritumoral margins cannot be achieved, making it challenging to secure an extended and effective ablation.
