AIM To compare survival and recurrence after laparoscopic liver resection(LLR) and laparoscopic radiofrequency ablation(LRFA) for the treatment of small hepatocellular carcinoma(HCC).METHODS Between June 1, 2005 and November 30, 2010, 46 patients(62.26 ± 8.55 years old; female/male: 12/34) treated for small HCC were enrolled following strict criteria. Patients with better liver function and larger tumors were referred for LLR(n = 24), while those with poorer liver function and multiple tumors were referred for LRFA(n = 22), and they were then followed for similar durations(44.74 ± 21.3 mo for LLR vs 40.27 ± 30.8 mo for LRFA). RESULTS The LLR and LRFA groups were homogeneous with regard to age, sex, etiology of liver cirrhosis, and AFP levels. The overall survival(OS) and disease-free survival(DFS) probability was 0.354 and 0.260, respectively. A significantly higher OS was observed in the LLR group(LLR: 0.442; LRFA: 0.261; P = 0.048), whereas no statistical difference was found for DFS(LLR: 0.206; LRFA: 0.286; P = 0.205). In the LRFA group was treated a greater number of nodules(LLR: 1.41 ± 0.77; LRFA: 2.72 ± 1.54; P < 0.001). Cox regression analysis found the number of intraoperative HCC nodules as the unique variable statistically significant for OS(hazard ratio: 2.225; P < 0.001). The rank-hazard plot showed a steeper increase of relative hazard for intraoperative nodules > 2.CONCLUSION Our preliminary results confirm the superiority of hepatic resection on thermoablation in the treatment of small HCC in selected patients, when both approaches are made laparoscopically. LLR showed better results compared to LRFA in terms of OS. These data need to be confirmed by further studies on a larger number of patients. AIM To compare survival and recurrence after laparoscopic liver resection (LLR) and laparoscopic radiofrequency ablation (LRFA) for the treatment of small hepatocellular carcinoma (HCC). METHODS Between June 1, 2005 and November 30, 2010, 46 patients (62.26 ± 8.55 years Patients with better liver function and larger tumors were referred for LLR (n = 24), while those with poorer liver function and multiple tumors were referred for LRFA (n = 22), and they were followed for similar durations (44.74 ± 21.3 mo for LLR vs 40.27 ± 30.8 mo for LRFA). RESULTS The LLR and LRFA groups were homogeneous with regard to age, sex, etiology of liver cirrhosis , and AFP levels. The overall survival (OS) and disease-free survival (DFS) probability was 0.354 and 0.260, respectively. A significantly higher OS was observed in the LLR group (LLR: 0.442; LRFA: 0.261; , no no statistical difference was found for DFS (LLR: 0.206; LRFA: 0.286; P = 0.205). In the LRFA group was treated a greater number of nodules (LLR: 1.41 ± 0.77; LRFA: 2.72 ± 1.54; of intraoperative HCC nodules as the unique variable statistics for OS (hazard ratio: 2.225; P <0.001). 2. Conclusions Our preliminary results confirm the superiority of hepatic resection on thermoablation in the treatment of small HCC in selected patients, when both approaches are made laparoscopically. LLR showing better results compared to LRFA in terms of OS. These data need to be confirmed by further studies on a larger number of patients.