AIM:To determine which treatment modality-hepatectomy or percutaneous ablation-is more beneficialfor patients with small hepatocellular carcinoma(HCC)(≤4 cm)in terms of long-term outcomes.METHODS:A retrospective analysis of 149 patientswith HCC≤4 cm was conducted.Eighty-five patientsunderwent partial hepatectomy(anatomic in 47 and non-anatomic in 38)and 64 underwent percutaneous ablation(percutaneous ethanol injection in 37,radiofrequencyablation in 21,and microwave coagulation in 6).Themedian follow-up period was 69 mo.RESULTS:Hepatectomy was associated with largertumor size(P<0.001),whereas percutaneous ablationwas significantly associated with impaired hepaticfunctional reserve.Local recurrence was less frequentfollowing hepatectomy(P<0.0001).Survival wasbetter following hepatectomy(median survival time:122 mo)than following percutaneous ablation(mediansurvival time:66 mo;P=0.0123).When tumor size wasdivided into≤2 cm vs>2 cm,the favorable effectsof hepatectomy on long-term survival was seen onlyin patients with tumors>2 cm(P=0.0001).The Coxproportional hazards regression model revealed thathepatectomy(P=0.006)and tumors≤2 cm(P=0.017)were independently associated with better survival.CONCLUSION:Hepatectomy provides both better localcontrol and better long-term survival for patients withHCC≤4 cm compared with percutaneous ablation.Ofthe patients with HCC≤4 cm,those with tumors>2 cm are good candidates for hepatectomy,provided thatthe hepatic functional reserve of the patient permitsresection. AIM: To determine which treatment modality-hepatectomy or percutaneous ablation-is more beneficial for patients with small hepatocellular carcinoma (HCC) (<4 cm) in terms of terms-long-term outcomes. METHODS: A retrospective analysis of 149 patients with HCC≤4 cm was five follow-up partial hepatectomy (anatomic in 47 and non-anatomic in 38) and 64 underwent percutaneous ablation (percutaneous ethanol injection in 37, radiofrequency ablation in 21, and microwave coagulation in 6) .The medium follow-up period was 69 mo .RESULTS: Hepatectomy was associated with large tumor size (P <0.001), while percutaneous ablation was significantly associated with impaired hepatic functional reserve. Local recurrence was less frequent follow hepatectomy (P <0.0001). Survival wasbetter following hepatectomy (median survival time: 122 mo) than following percutaneous ablation (mediansurvival time: 66 mo; P = 0.0123) .When the tumor size wasdivided into≤2 cm vs> 2 cm, the favorable effects of hepatectomy on long-term su The Cox proportional hazard regression model revealed that the hepatectomy (P = 0.006) and tumors ≤ 2 cm (P = 0.017) were independently associated with better survival. CONCLUSION: Hepatectomy can both better local control and better long-term survival for patients with HCC ≤ 4 cm compared with percutaneous ablation. Patients with HCC ≤ 4 cm, those with tumors> 2 cm are good candidates for hepatectomy, provided that the hepatic functional reserve of the patient permits rection.