Recent evidence in the treatment of small hepatocellular carcinoma.

With the introduction of percutaneous local ablation therapy (PLAT) including radiofrequency ablation and percutaneous ethanol injection in clinical settings, the treatment of small hepatocellular carcinoma (HCC) has dramatically changed. In this article, we review recent evidence regarding the treatment of small HCC based on articles published after January 2003. Twenty-five articles were eligible for analysis with 6 evidence level-1 articles and 2 evidence level-2 articles. Geographically, about two-thirds of studies (17 articles, 68%) were carried out in Asia. Among these studies, 2 randomized controlled trials (RCTs) comparing the effectiveness of hepatectomy with that of PLAT are noteworthy. Both RCTs concluded that each PLAT was as effective as surgical resection in the treatment of small HCC. However, the external validity of these RCTs is questionable. Therefore, multicenter high-quality RCTs should be performed to obtain more reliable evidence in the treatment of small HCC.