Thirteen studies were included (1,266 patients received liver resection and 620 received radiofrequency ablation). Twelve studies were retrospective and one was prospective.
Liver resection was significantly superior to radiofrequency ablation in three-year overall survival (RR 1.38, 95% CI 1.25 to 1.52; Ι²=57%; 12 studies), five-year overall survival (RR 1.47, 95% CI 1.28 to 1.69; Ι²=22%; 12 studies), three-year disease-free survival (RR 1.74, 95% CI 1.48 to 2.03; Ι²=65%; 10 studies) and five-year disease-free survival (RR 2.23, 95% CI 1.82 to 2.72; Ι²=72%; 10 studies). Results for all subgroups indicated similar effects.
Postoperative morbidity was significantly higher in patients who received liver resection (RR 2.5, 95% CI 1.88 to 3.31; Ι²=61%; nine studies). No significant difference was found in postoperative mortality. Patients who received liver resection had a significantly longer hospital stay (SMD 3.28, 95% CI 3.05 to 3.52).
There was no evidence of publication bias.