Comparative surgical approaches for early-stage hepatocellular carcinoma. A single-center experience

Hepatocellular carcinoma (HCC) remains a major global health concern, ranking among the top causes of cancer-related mortality. This study aims to assess and compare the outcomes of three curative surgical approaches-hepatic resection (HR), radiofrequency ablation (RFA), and liver transplantation (LT)-in patients with early-stage HCC. Materials and methods:  We conducted a prospective analysis of 105 patients with BCLC stage 0-B HCC treated between 2015 and 2020 at a tertiary center in Romania. Patients were divided into three treatment groups:  Group I (n=64) underwent HR, Group II (n=29) received RFA, and Group III (n=12) underwent LT according to Milan Criteria. Baseline liver function, tumor characteristics, operative details, and postoperative outcomes were recorded. The HR group was further stratified by transection technique (Habib device vs. crush-clamping). Results:  The mean age differed significantly across groups (p=0.013), with LT patients being younger. Child-Pugh class A was predominant in HR (84.38%) and RFA (72.41%) groups, while B and C were more frequent in LT. Blood loss was significantly lower with the Habib device compared to crush-clamping (p=0.003). No recurrence was recorded in the LT group during follow-up, while recurrence rates were 56.52% for RFA and 31.67% for HR (p=0.003). The overall postoperative complication rate did not differ significantly among groups. Early mortality rates were 6.25% (HR), 10.34% (RFA), and 8.33% (LT). Our findings suggest that all three treatment modalities can be effective for early-stage HCC when selected according to patient-specific liver function and tumor burden. HR and RFA remain viable first-line options in compensated liver disease, while LT provides the most durable oncologic outcomes but is limited by eligibility and organ availability. The use of the Habib device, may reduce intraoperative blood loss in hepatic resections. Conclusions:  Hepatic resection and radiofrequency ablation remain valid treatment options for early-stage HCC in patients with well-compensated liver function, while liver transplantation offers the most favorable long-term oncologic outcomes when applied within established criteria. A multidisciplinary, patient-centered approach is essential to maximize survival and minimize recurrence in HCC management.