Results of a randomized trial of 168 patients showed that radiofrequency ablation (RFA) for early-stage hepatocellular carcinoma was as effective as surgical resection. Whether early-stage hepatocellular carcinoma should be treated with surgical resection or RFA has been debated. For this reason, the researchers compared the effectiveness of the two treatments. The number of patients included in the study was one to two tumors, <4 cm in diameter. Patients were randomly assigned to receive either RFA or surgical resection in 84 cases in both groups, mostly men, with a mean age of about 50 years. A total of 85% of patients had positive hepatitis markers in the blood, mostly positive for hepatitis B surface antigen. There were no significant differences in baseline ALT, methemoglobin, or tumor size, number, grading, or other characteristics between the two groups. The results showed that 81 (96%), 74 (88%) and 63 (75%) patients survived at 1, 2 and 3 years in the surgical group and 78 (93%), 70 (83%) and 57 (68%) patients in the RFA group, respectively, with no significant group differences (P=0.3). The number of tumor recurrence at 3 years was 27 (32%) and 35 (42%) in the surgical and RFA groups, respectively, and there was no significant difference. the complication rate was about 10% in the RFA group, including 2 cases of bleeding, and >20% in the surgical group, including 2 patients with bleeding requiring emergency open surgery and 1 patient with liver abscess. The mean time for RFA and surgery was 41 min and 141 min, respectively, and the mean blood loss was 21 ml and 375 ml, respectively, with many surgical patients requiring blood transfusion. Patient length of stay was approximately 1 week vs. >2 weeks. residual tumor was detected in 8 patients with RFA: 6 were located subperitoneally, 1 adjacent to the gallbladder, and 1 adjacent to the main portal vein, but inclusion or exclusion of these patients had no significant effect on 3-year survival outcome. The investigators noted that for patients with the presence of one to two tumors <4 cm in diameter, overall and recurrence-free survival with RFA treatment was similar to that with surgical resection, but had the advantage of being minimally invasive and having a low risk of complications. In addition, the cost of RFA is relatively low. Dr. Jake Liang, AASLD president and director of the National Institute of Diabetes, Digestive and Kidney Diseases (NIDDK) Liver Disease Research Division, commented that the results of the study answer the question of which option is better. Since there is no difference in efficacy between the two, the most cost-effective option should be chosen. In addition, surgical resection is particularly difficult for patients with cirrhosis. The incidence of liver cancer is currently on the rise, mainly due to viral hepatitis. The best treatment for liver cancer is liver transplantation, and early liver transplantation has a very high cure rate, but not all patients can be treated with liver transplantation due to the problem of liver supply.