Surgery vs Ablation for Small Liver Cancer Shows No Survival Difference

This groundbreaking study challenges the traditional preference for surgery in treating small hepatocellular carcinoma (HCC), the most common form of liver cancer. The research matters because it provides the first high-quality randomized evidence comparing these two standard treatments for early-stage liver cancer.

The SURF trial enrolled 1,094 patients across 49 Japanese institutions between 2009-2015, with 302 patients in the randomized trial and 753 in an observational cohort. Patients had liver tumors with a largest diameter ≤3 cm and ≤3 nodules total. Most participants (90%) had solitary tumors, and 65% had tumors ≤2 cm.

After 5 years of follow-up, the results showed remarkably similar outcomes between treatments. Overall survival was 74.6% for surgery versus 70.4% for radiofrequency ablation, while recurrence-free survival was essentially identical at 42.9% versus 42.7%. Importantly, serious adverse effects occurred in 3.3% of surgery patients but none in the ablation group.

These findings suggest that for patients with small HCC, radiofrequency ablation may be preferable due to its similar effectiveness but superior safety profile. This could significantly impact treatment decisions, potentially sparing many patients from major surgery while achieving equivalent cancer control. The results support a more personalized approach to liver cancer treatment, where patient factors and preferences can guide the choice between equally effective options.