Small tumors, big decisions: Rethinking resection and ablation in early hepatocellular carcinoma

Table 1 Summary table of recent meta-analyses

Ref.	Population/setting	Interventions	Main findings	Conclusion
[16]	Small HCC ≤ 5 cm	Resection vs RFA	Resection better OS/RFS	Surgery superior
[17]	HCC ≤ 5 cm stratified	Resection vs RFA	Benefit across sizes	Surgery > RFA
[18]	Early HCC	Laparoscopic liver resection vs RFA	Better OS/DFS; less recurrence	Laparoscopic liver resection preferred
[19]	Elderly ≥ 65	Resection vs RFA	Better OS/DFS	Age not exclusion for surgery
[20]	Recurrent HCC	Repeat resection vs RFA	Better OS	Resection preferred
[22]	Early-stage HCC (RCTs)	Resection vs RFA	OS similar; DFS trend favoring resection	Evidence inconclusive
[23]	Solitary HCC ≤ 3 cm	Resection vs RFA	LR better OS/DFS/RFS (PS-matched)	LR preferred
[24]	Early-stage HCC (RCTs)	Ablation vs resection	Non-inferiority not demonstrated	Resection favored
[25]	Solitary HCC ≤ 3 cm	LT vs LR vs ablation	LT > LR > ablation	Hierarchical efficacy
[11]	Ablation RCT NMA	RFA, microwave ablation, PEI, transcatheter arterial chemoembolization, stereotactic ablative body radiation therapy	RFA > PEI	Defines non-surgical hierarchy
[29]	Larger HCC	Hepatic arterial + transcatheter arterial chemoembolization vs mono	Improved OS/local control	Good alternative

HCC: Hepatocellular carcinoma; RCT: Randomized controlled trial; RFA: Radiofrequency ablation; LT: Liver transplantation; LR: Liver resection; PEI: Percutaneous ethanol injection; OS: Overall survival; RFS: Recurrence-free survival; DFS: Disease-free survival; PS: Propensity score.