Ten studies (one randomised controlled trial and nine non-randomised controlled trials) were included in the review (n=1,411 participants). Median/mean duration of follow-up ranged from 21.9 to 43 months.
There was no significant difference in overall survival between the radiofrequency ablation and hepatic resection groups at one year (ten trials). Compared with radiofrequency ablation, there was a significantly higher rate of overall survival in the hepatic resection group at three years (OR 0.56, 95% CI 0.44 to 0.71; nine trials), but not at five years (OR 0.60, 95% CI 0.36 to 1.01; five trials). A significantly higher rate of disease-free survival rate was observed in the hepatic resection group at one year (OR 0.54, 95% CI 0.35 to 0.84; nine trials), three years (OR 0.44, 95% CI 0.28 to 0.68; eight trials) and five years (OR 0.64, 95% CI 0.42 to 0.99; four trials)
Radiofrequency ablation was associated with a significantly higher rate of local intrahepatic recurrence compared to hepatic resection (OR 4.50, 95% CI 2.45 to 8.27; five trials), but a significantly lower rate of postoperative morbidity (OR 0.29, 95% CI 0.13 to 0.65; six trials). No significant difference in the rate of distant intrahepatic recurrence was found between the two groups. There was no significant difference in mortality between the two groups.
Significant heterogeneity was observed in the outcomes of five-year overall survival (I2= 61.6%), one-year disease-free survival (I2=59.2%), three-year disease-free survival (I2= 66.7%) and morbidity (I2=72.7%).
Subgroup analyses on patients with tumours of 3cm or less (three studies) showed no significant difference in overall or disease-free survival between the two treatment groups at one, three and five years.