A Comparative Study of Radiofrequency Ablation, Microwave Ablation, and Percutaneous Ethanol Injection in Treatment of Hepatocellular Carcinoma—A Single-Center Experience

<b>Background/Objectives</b>: Hepatocellular carcinoma (HCC) ranks as the third most prevalent cancer and is the second leading cause of cancer-related deaths globally. This study sought to evaluate microwave ablation (MWA), radiofrequency ablation (RFA), and percutaneous ethanol injection (PEI)-whether used separately or together (RFA+PEI, MWA+PEI)-for treating single HCC lesions ≤5 cm, focusing on outcomes, survival rates, complications, costs, and recurrence rates. <b>Methods</b>: This retrospective-prospective research study involved 250 patients with solitary HCC lesions measuring ≤5 cm, recruited from the National Liver Institute at Menoufia University. Patients were evenly divided into five groups, each containing (<i>n</i> = 50): RFA, MWA, PEI, combined RFA+PEI, and combined MWA+PEI. Indications and contraindications adhered to the Barcelona Clinic Liver Cancer (BCLC) guidelines. <b>Results</b>: Three patients were administered antiviral therapy 1-2 years after ablation. Average intervention costs were 17,340 ± 700, 31,200 ± 900, 1140 ± 300, 17,500 ± 0.0, and 33,800 ± 0.0 EGP for groups 1 through 5, respectively. Short-term advancement rates were 12%, 8%, 18%, 4%, and 2%. After 36 months, all patients survived six months after ablation. Average survival durations were 2.44 ± 1.17, 2.59 ± 1.02, 2.69 ± 0.99, 2.83 ± 1.06,and 2.91 ± 1.04 years, respectively. Complications were mainly minor (pain, nausea, and low-grade fever); one patient experienced an abscess and biloma post-MWA, one experienced minimal pleural effusion, and two combined-therapy cases had abdominal wall hematoma. <b>Conclusions</b>: RFA, MWA, and PEI-whether used individually or together-are successful treatment choices for early-stage HCC. The combination of MWA and PEI demonstrated the most favorable results, minimal recurrence rates, and the longest duration of progression-free survival.