Laparoscopic Hepatectomy Versus Radiofrequency Ablation for Solitary Hepatocellular Carcinoma ≤3 cm: A Retrospective Cohort Study

Abstract Background Hepatocellular carcinoma (HCC) is commonly treated with curative-intent approaches, including laparoscopic hepatectomy (LH) and radiofrequency ablation (RFA), in patients with early-stage disease. However, the comparative effectiveness of these two treatment modalities in patients with solitary HCC measuring ≤3 cm remains unclear. This study aimed to compare the therapeutic outcomes and recurrence patterns between LH and RFA in patients with primary solitary HCC measuring ≤3 cm. Methods This study is a single-center retrospective analysis conducted at Tianjin Medical University Cancer Institute & Hospital, which enrolled 383 patients with primary, solitary HCC measuring ≤ 3 cm in diameter who underwent LH and RFA. All patients were newly diagnosed and had not received prior treatment. The primary endpoints included overall survival (OS) and recurrence-free survival (RFS). Propensity score matching (PSM) and inverse probability of treatment weighting (IPTW) were performed to adjust for differences in baseline characteristics between the two treatment groups, followed by longitudinal follow-up to evaluate long-term survival and recurrence outcomes. Results The findings indicated that there was no statistically significant difference in OS outcomes between the two treatment modalities (P=0.25). However, LH was associated with a lower recurrence rate compared with RFA (7.7% vs. 22.9%) and longer RFS (P=0.02). This difference remained statistically significant after PSM and IPTW adjustment (P=0.0068 and P=0.02). Among patients with tumors measuring ≤2 cm, no statistically significant difference in RFS was observed in the overall cohort, after PSM, or after IPTW adjustment (P=0.074, P=0.061, and P=0.074, respectively). Among patients with tumors measuring >2 to ≤3 cm, LH was associated with improved RFS after PSM (P=0.042), whereas differences were not statistically significant in the unmatched analysis or IPTW-adjusted analysis. Conclusion In this retrospective cohort study of patients with solitary HCC measuring ≤3 cm, LH was associated with improved recurrence control compared with RFA, while no significant difference in OS was observed. Exploratory tumor-size subgroup analyses suggested a possible difference in RFS among patients with tumors measuring >2 to ≤3 cm, although this finding was not consistently observed across analytical approaches and the treatment-by-tumor-size interaction was not statistically significant. These findings require further validation in prospective studies.