Liver cancer is highly prevalent and harmful in China. Although surgical treatment (including liver transplantation and hepatectomy) can often achieve better results, only about 20% of patients are able or willing to undergo surgical treatment due to the heavy degree of cirrhosis, the central location of the tumor, and many concomitant diseases, as well as factors such as many complications and high costs of surgical treatment. To further improve the efficacy of non-surgical treatments, to allow more patients to obtain satisfactory treatment results through minimally invasive treatment, and to maintain liver function reserve and quality of life to the greatest extent, and to reduce the cost of medical resources, is undoubtedly the most important direction of clinical development for liver cancer in China. In the past decade, local treatment modalities represented by radiofrequency ablation have made great development and achieved satisfactory therapeutic effects, and gradually become the mainstream modality of liver cancer treatment. However, compared with the survival efficacy and social benefits that radiofrequency ablation can produce, the acceptance level of both doctors and patients in China has yet to be further improved. As one of the earliest hepatobiliary surgeons in China, we would like to summarize the work of radiofrequency ablation for liver cancer in China over the past ten years, analyze the current situation and look forward to the future, with the aim of further improving the scientific application of this work in China and benefiting more liver cancer patients. Radiofrequency ablation, as a treatment for liver cancer, is very “moderate” The principle of radiofrequency ablation treatment for liver cancer is to put radiofrequency ablation electrodes into the tumor, which causes positive and negative ions in the cancer tissue to vibrate at high speed and generate heat by friction with radiofrequency current. Compared with traditional surgical treatment and interventional embolization, radiofrequency ablation has outstanding characteristics: on the one hand, the way of radiofrequency ablation for liver cancer is local, the principle is physical, the means is minimally invasive, and there is no over-aggressive means; on the other hand, the efficacy of radiofrequency ablation for liver cancer is definite, and for patients with good indications, it has curative efficacy, its main disadvantage –high residual rate of cancer foci can also be dissolved by strategies such as repeated radiofrequency ablation. The main disadvantage – the high residual rate of cancer foci – can be solved by repeated RF ablation strategies. The development of radiofrequency ablation for liver cancer started in 1989 abroad and was launched in 1999 in China. The ten-year development process in China can be roughly divided into three stages. The first stage was from 1999 to 2003, characterized by “crossing the river by feeling the stones”. Initially, physicians began this work with trepidation, not knowing how much survival benefit this approach would bring to patients. As the work progressed, physicians gained experience and awareness, and gradually established a technical platform and theoretical system to ensure safety and improve outcomes from the perspective of radiofrequency ablation therapy. The most outstanding achievement of this stage is that with the addition of specialized hepatobiliary surgeons, the diversification of the team was achieved and the transformation from a single percutaneous puncture treatment mode to a diversified treatment mode was completed. The second phase was from 2004 to 2007. Although the work in the first phase was only a “point” breakthrough, with a narrower influence, and had little impact on the treatment pattern of liver cancer, which was dominated by surgical treatment, doctors gradually realized that this technology had definite efficacy for early liver cancer, and had the advantages of being less invasive, less expensive, and easily accepted by patients. Further, physicians’ self-confidence further increased and cautiously applied this technology to early-stage liver cancer, even small liver cancer, and studied it in comparison with traditional treatment modalities such as liver transplantation or liver resection in an attempt to be able to replace traditional surgical treatment in a certain patient population, sparing patients the pain of surgery and saving medical costs. This phase of work can be characterized as “everything is free” in terms of physicians’ mindset and aspirations. The third phase is from 2008 to the present. With the emergence of convincing evidence from domestic and international studies, people were surprised to see that the efficacy of radiofrequency ablation is comparable to liver transplantation and liver resection for early-stage liver cancer, and even better than surgery for many small liver cancers. This has greatly encouraged the motivation for in-depth research and widespread development, with the aim of making minimally invasive treatment based on radiofrequency ablation therapy to replace traditional surgical treatment on a larger scale. At present, many treatment centers are carrying out standardized and rigorous clinical comparison studies, which can be described as “trying to compete with the sky”. The development of radiofrequency ablation therapy over the past ten years has been a process of mutual reference, joint application and conceptual integration with traditional liver cancer treatment methods, and a process of continuous improvement of safety and efficacy. During this period, physicians have done a lot of innovative work in dozens of aspects in more than ten nodes in the three links of preoperative, intraoperative and postoperative, and have obtained systematic achievements and systemic advancement. The main milestones include: the selection of surgical indications is more rational and scientific; the adoption of more precise guidance means such as CT guidance and the auxiliary measures of tracheal intubation to control breathing, which further improves the efficiency and accuracy of RF ablation needle puncture and needle deployment; at the same time, general anesthesia measures eliminate the pain of patients during treatment and greatly improve the patient’s compliance and tolerance; and the cooperation with laparoscopic techniques In addition, the combined application of laparoscopic techniques, open surgery, transarterial interventional embolization, anhydrous alcohol injection, and drug placement; optimization of postoperative follow-up pathways; the concept of complete pathological ablation in determining the efficacy; the application of repeated RF ablation strategies in further improving the efficacy; and the significant improvement in the functions of special equipment such as RF ablation needles and generators, etc. The above-mentioned multifaceted achievements have elevated the safety and efficacy of RF ablation treatment to a new starting point. The potential of radiofrequency ablation as a curative tool is becoming more and more prominent, and gradually becoming another curative treatment modality after liver transplantation and hepatectomy. In addition, radiofrequency ablation, as a member of the family of local treatment for liver cancer, has become the preferred modality for local treatment of liver cancer due to its certainty of efficacy, extensiveness of implementation, simplicity of operation and universality of promotion. Minimally invasive treatment based on radiofrequency ablation has become the “troika” of clinical treatment for liver cancer together with the above two traditional surgical methods. With the implementation of China’s medical development strategy in the next ten years, the screening of small liver cancer will be further popularized, and more and more liver cancers will be detected at the early stage of liver cancer or small liver cancer; with the further understanding of the efficacy of radiofrequency ablation, more and more physicians, especially surgeons, will take up the treatment. With the further understanding of the efficacy of RF ablation, more and more physicians, especially surgeons, will take up the weapon of RF ablation to treat liver cancer, more and more liver cancer patients will trust and accept this minimally invasive technology, and more and more early stage liver cancer or small liver cancer will obtain satisfactory long-term efficacy through local treatment mainly by RF ablation. Undoubtedly, the above-mentioned development trends will lead us into the “era of minimally invasive treatment for early-stage liver cancer”. Of course, we are also aware that the arrival of the era of minimally invasive treatment for early stage liver cancer is inseparable from the updating of surgeons’ treatment concept and the transformation of their working style. Although the road is long, the future is bright. If we count the development history of surgery, we can easily find that the surgical treatment work of surgeons has obvious stage characteristics. Once the surgeons were busy on the operating table of gastroduodenal ulcers, or perhaps, the majority of surgical treatment is no longer needed, through the drug can be cured; once need to “open the knife” to get healed gallbladder stones, or perhaps, through the minimally invasive laparoscopic technology that can be removed, the traditional open cholecystectomy, is is going into history. So, will the treatment pattern of liver cancer also be transformed in the near future? Although traditional surgery will still be the first choice of treatment for certain patients, the era of minimally invasive treatment for early stage liver cancer is already “a ship standing on the shore looking at the sea where the tip of the mast is already visible, and a sunrise standing on the top of a mountain looking at the east where the light is already shining. “