Table 1 Comprehensive overview of the included Studies
Study ID | Country, Study design, Study duration | Sample size of each group | Inclusion Criteria | Type of Resection, The surgical method | Type of RFA | Conclusion | Complications | NOS SCORE |
|---|---|---|---|---|---|---|---|---|
song 2015 [30] | China, retrospective study,2.6 years | LLR (n =78) RFA (n=78) | • Age: 18–75 years • Definitive diagnosis of primary liver cancer • Single liver tumor: Diameter <4 cm, no vein invasion, lymph node or other metastasis • Liver function: Child–Pugh grade A or B, indocyanine green retention rate <30%at 15 min, platelet count >50 x 10^9/L, thrombin time <5 s • No history of prior treatments: trans arterial chemoembolization, surgery, chemotherapy, or other anti−tumor treatments • Eastern Cooperative Oncology Group score >2 | Laparoscopic, 50%were anatomical liver resection | PRFA | There was no difference between LH and RFA in terms of OS in patients with a single, small HCC | Not reported | 9 |
LAI 2016 [36] | China, retrospective study,3 years | LLR (n=28), RFA (n=33), or OH (n=33) | • First diagnosed with HCC and completed treatments at the hospital • Maximum tumor diameter <3 cm, or single lesion <5 cm • Number of intrahepatic tumors≤3 • Child–Pugh class A or B • BCLC stage 0 or A • No intrahepatic or distant metastases • No invasion of specified veins • Indocyanine green retention rate <30%at 15 min • Suitable for LH, RFA, or OH according to guidelines | Laparoscopic, the surgical method not reported | PRFA | Laparoscopic hepatectomy is more effective than PRFA for small HCC, showing similar results to OH but with less trauma. LH is preferred for those under 60, while older patients can choose surgery or PRFA | Not reported | 7 |
Harada2016 [38] | Japan, retrospective study PSM,6 years | LLR group (n =81), RFA group (n =40) | • Tumors≤3 cm in size, max three tumors or solitary tumor≤5 cm • Diagnosis of portal hypertension (PHT) required presence of EVs and/or platelet count <100,000/µL with splenomegaly • EV presence determined preoperatively via upper gastrointestinal endoscopy • Splenomegaly defined as spleen length >10 cm on preoperative CT | Laparoscopic, 25%were anatomical liver resection | PRFA | By reducing postoperative complications, LR may be a treatment option for patients with BCLC stage 0 or A HCC and PHT | Shoulder pain, ascites superficial surgical site, infection, colitis cholangitis, delirium , bile leakage, pneumonia, atrial fibrillation, deep vein thrombosis, urinary tract infection, pleural effusion, deep surgical site infection, liver failure | 8 |
Casaccia 2017 [15] | Italy, retrospective study,6 years | LLR(n=24), LRFA (n=22) | • Patients evaluated for liver disease severity using Child–Pugh classification • Plasma levels of alfa−fetoprotein (AFP) measured | Laparoscopic, Most resections were anatomic | LRFA | Initial findings show hepatic resection's superiority over thermoablation for laparoscopic treatment of selected small HCC cases. LLR outperformed LRFA in terms of OS. Larger studies are needed to validate these results | Not reported | 8 |
Santambrogio 2017 [31] | Italy, retrospective study,5 years | LLR (n =59), LRFA (n =205) | • Study focused on HCC patients treated with LLR or RFA from 1998 to 2017 • Inclusion criteria: • Single lesion • Tumor size < 3 cm • Good liver function (Child–Pugh class A) • < 2 segments resected • Treated once with LRFA or LLR • Comorbidities assessed using Charlson's index • Treatment decisions guided by BCLC staging and tumor location | Laparoscopic, 51%were anatomical liver resection | LRFA | Our data favor hepatic resection for single nodules and good liver function. Thermoablation is suitable for complex cases or poor prognosis, allowing a less invasive approach. | Abdominal wall hematoma, ascites, mild acute encephalopathy, hemoperitoneum, jaundice, transient renal failure, other complications | 8 |
Yamashita 2018 [27] | Japan, retrospective study,10 years | LLR (n=38), RFA (n=62) | • Primary HCC within the Milan criteria | Laparoscopic, LLR were anatomical and non−anatomical resections | PRFA or LRFA | In severe cirrhosis, multimodal RFA for HCC offers less invasiveness, shorter hospital stays, and maintains patient survival. Consider rethinking the standard treatment for primary HCC within Milan criteria to include multimodal RFA for severe cirrhosis cases | Not reported | 8 |
Tsukamoto 2019 [29] | Japan, retrospective study,8.3 years | LLR (n=77), LRFA (n=94) | • HCC within the Milan criteria | Laparoscopic, the surgical method not reported | LRFA | For patients with severely impaired liver function, consider E-RFA as a suitable initial treatment for HCC. However, avoid using E-pHR as the primary treatment in these cases | Not reported | 8 |
Chong 2019 [39] | China, retrospective study PSM,12 years | LLR (n =59) RFA (n =155) | • Patients underwent curative liver resection or RFA for primary HCC • Minimally invasive approach: laparoscopic, robotic hepatectomy, percutaneous, or laparoscopic RFA • BCLC stage 0/A • Resection for subcapsular, solitary, or oligonodular tumors with good liver function and sufficient liver remnant • RFA for cirrhotic patients with small/deep tumors, especially if percutaneous approach feasible • Patient preferences considered if both treatments suitable | laparoscopic or robotic, the surgical method not reported | PRFA or LRFA | In early-stage HCC, MIH offered improved long-term survival compared to RFA, without added complications. When possible, MIH should be prioritized as the primary treatment for these patients | Not reported | 7 |
Pan 2019 [32] | China, retrospective study PSM,3.3 years | LLR (n =163), RFA (n =314) | • Initial HCC diagnosis via histology or noninvasive AASLD criteria • Solitary tumor≤5.0 cm or multiple tumors (≤3), each≤3.0 cm • Visible lesions on ultrasound with safe path for percutaneous treatment • No extrahepatic metastasis, confirmed by enhanced CT or MRI • Child–Pugh class A or B • Eastern Cooperative Oncology Group performance status of 0 | Laparoscopic, 37.4%were anatomical liver resection | PRFA | In early-stage HCC patients, MIH yielded superior long-term survival compared to RFA, without raising complication rates. When possible, MIH should be considered as the preferred initial treatment for this patient group | Allergic shock, postoperative heart failure, postoperative respiratory failure, ascites, pain, fever, vomiting | 8 |
Lee 2020 [44] | Korea, retrospective study,6.6 years | LLR (n =251), p−RFA (n =315) | • Single nodular HCCs≤3 cm • Treated with LLR (laparoscopic liver resection) or p−RFA (percutaneous radiofrequency ablation) • No prior treatment for HCC • No macrovascular invasion or extrahepatic metastasis • Child–Pugh class A liver function • Absence of significant co−existing medical conditions, except HCC | Laparoscopic, the surgical method not reported | PRFA | For small single HCCs located subcapsularly, perivascularly, and anteroinferolaterally, LLR can offer notably improved local tumor control compared to PRFA As such, LLR may be the preferred treatment option | Not reported | 6 |
Lin 2020 [35] | Taiwan, retrospective study,5 years | LLR (n=36), RFA (n=39) | • Single subcapsular HCC≤2 cm in diameter • Child–Pugh class A liver cirrhosis • Primary treatment with percutaneous CT−or ultrasound−guided RFA or minimally invasive surgery (MIS), including laparoscopic or robotic−assisted approaches | MIS, including laparoscopic or robotic, the surgical method not reported | PRFA | Among patients with single subcapsular HCC (≤ 2 cm), Child–Pugh A liver function, and no significant portal hypertension, demonstrated superior 7-year OS, RF), and DFS compared to PRFA | Not reported | 8 |
Ogiso 2020 [33] | Japan, retrospective study,5 years | LLR(n=85), RFA (n=136) | • BCLC stage 0 or A • Tumor size≤3 cm • Up to 3 nodules • No macrovascular involvement • Child Pugh class A or B | Laparoscopic, the surgical method not reported | PRFA | RFA is less invasive, although both LLR and RFA are safe and effective. LLR provides better local control with superior recurrence−free and local−recurrence free survival. These results help optimize treatment selection based on patient−specific factors | Not reported | 8 |
Wu 2020 [42] | China, Prospective study,1 year | LLR (n =35), RFA (n =20) | • Early−stage HCC defined as per specific criteria: • BCLC Stage 0 or A • Tumor size≤3 cm • Up to 3 nodules • No macroscopic vascular invasion or extrahepatic spread • Child–Pugh class A or B | Laparoscopic, the surgical method not reported | PRFA | Ablation is a safe and cheap way to treat PHC at an early stage for its wonderful performance in the postoperative short-term outcome | Not reported | 8 |
Xu 2021 [28] | China, retrospective study,2 years | LLR group (n=48), RFA group (n=46) | • Single tumor≤6 cm diameter • Diagnosis confirmed by multiple exams (ultrasound, CT, MRI, or puncture) • Patients not in decompensated cirrhosis stage • No invasion of portal vein, hepatic arteriovenous, or inferior vena cava • No metastasis outside the liver • Patients underwent LH (likely laparoscopic hepatectomy) or RFA | Laparoscopic, LLR were anatomical hepatectomy | PRFA | RFA and LH have similar effects in the treatment of small HCC. And RFA has the advantages of less trauma, shorter operation duration, and quick postoperative recovery | Abdominal infection, bleeding, biliary fistula pleural effusion | 7 |
Kim 2021 [43] | Korea, retrospective study PSM,10 years | LLR (n =101) RFA (n =264) | • Single tumor≤4 cm diameter • No metastasis or vascular invasion • New diagnosis without prior surgical resection or non−surgical HCC treatment • HCC located in AL segments (II, III, IVb, V, and VI) | Laparoscopic, 59%were anatomical liver resection | PRFA | For patients with a single, small HCC located in the anterolateral segments of the liver, LLR was associated with similar complication and overall survival rates, but better disease−free survival compared with RFA. LLR may be recommended for patients with higher α−fetoprotein levels | Organ injury, fluid collection, urinary complication, pulmonary complication, skin burn, others | 8 |
Conticchio 2021 [40] | Italy, retrospective study PSM,3 years | RFA (n=98), LLR (n=86) | • Child–Pugh class A and B • Age≤70 years • Single hepatocellular carcinoma≤3 cm diameter • No major portal/hepatic vein branch invasion • No extrahepatic disease | Laparoscopic, anatomical and non− anatomical liver resection | PRFA or LRFA | Despite a longer length of hospital stay and operative time, LLR guarantees a comparable postoperative course and a better OS and DFS in elderly patients with single HCC ( 3 cm), located in anterolateral segments | Liver failure, ascites, biliary leakage, hemorrhage, systemic infection, intra−abdominal abscess, wound infection, portal thrombosis, pulmonary, cardiac, renal | 8 |
Cheng 2022 [41] | China, retrospective study, 16.6−years | LLR (n=99), RFA (n=31) | • Patients underwent RFA or LLR for small HCC • Small HCC defined by: • BCLC stage 0 or A • Size≤3 cm • Up to 3 nodules on CT scan or MRI • No macrovascular invasion | Laparoscopic,45.5%were anatomical liver resection | PRFA | Both RFA and LLR are safe and feasible treatment options for patients with small HCC. LLR should be considered for patients with preserved liver function with a better DFS; while RFA offered a comparable OS with less surgical trauma and shorter hospital stay | Not reported | 7 |
Ko 2022 [37] | Korea, retrospective study PSM,6 years | LRFA (n =29), LLR (n =60) | • solitary subcapsular HCC between 1 and 3 cm | Laparoscopic, 58.3%were anatomical liver resection | LRFA | There was no significant difference in therapeutic outcomes between LHR and LRFA for single subcapsular HCCs measuring 1–3 cm. The difference in RFS should be further evaluated in a larger study | Not reported | 8 |
Liu 2022 [34] | Taiwan, retrospective study PSM,5 years | LLR, (n =119) RFA, (n =481) | • BCLC Stage 0 or A • Tumor size≤3 cm • Up to 3 nodules • No macroscopic vascular invasion or extrahepatic spread • Child–Pugh class A or B | Laparoscopic and robotic, the surgical method not reported | PRFA | After PSM, severe postoperative complication and OS rates were found to be comparable between the MIS and RFA groups, but RFS was higher in the MIS group than the RFA group, suggesting that MIS may have better outcomes for patients with early-stage HCC | Not reported | 6 |