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Background  Non‐anatomical liver resection (NAR) and radiofrequency ablation (RFA) are treatment options for early‐stage hepatocellular carcinoma (HCC). The aim was to compare the outcomes of NAR and RFA for HCC in patients with three or fewer tumour nodules, each measuring not more than 3 cm in maximum diameter.    Methods  Eligible patients undergoing NAR or RFA with curative intent between September 2002 and December 2014 were identified. A propensity score‐matching analysis was performed to reduce bias, and outcomes in these patients were analysed.    Results  From a total of 199 patients, 1:1 propensity score matching identified 70 matched pairs. Patients having NAR had a longer hospital stay (median 10 days  versus  4 days for those who had RFA;  P  < 0·001) and a higher morbidity rate (24  versus  10 per cent respectively;  P  = 0·042). Patients who had NAR had slightly better recurrence‐free survival but this failed to reach statistical significance in univariable analysis ( P  = 0·064). There was no significant difference in overall survival between the two groups ( P  = 0·475). RFA was identified as an independent risk factor for recurrence‐free survival (hazard ratio (HR) 1·57;  P  = 0·041) in multivariable analysis. Local recurrence was significantly more common in patients receiving RFA (23  versus  1 per cent;  P  < 0·001).    Conclusion  RFA was an independent risk factor for shorter recurrence‐free survival, with a significantly higher local recurrence rate than NAR. Despite these differences, overall survival was not affected.

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Propensity score‐matched comparison of non‐anatomical resection and radiofrequency ablation for hepatocellular carcinoma in patients with up to three tumours, each measuring up to 3 cm in diameter