To compare and explore the therapeutic effect of ultrasound-guided radiofrequency ablation (RFA) on hepatocellular carcinoma in the caudate lobe with diameter ≤ 5 cm, and analyze the feasibility and value of its clinical application.

From January 2016 to December 2020, 44 patients with hepatocellular carcinoma in the caudate lobe with diameter ≤ 5 cm treated in Qionghai People’s Hospital were retrospectively selected. According to the treatment methods, the patients were divided into ablation group (18 cases, with RFA under ultrasound guidance) and resection group (26 cases, with laparoscopic caudate lobectomy). The RFA effect and complete ablation rate were evaluated. The perioperative indexes, changes of liver function indexes before and after operation, postoperative complications and follow-up survival were compared between the two groups.

In the ablation group, the complete ablation rate was 83.3% (15/18), the complete ablation rate after supplementary ablation was 100.0%, and the number of ablation time were 1-2 (1.3±0.4). The operation time, liver function recovery time and postoperative hospital stay in the ablation group were shorter than those in the resection group, and the differences were statistically significant (t=19.053, 10.517, 12.590; all P<0.001). The levels of total bilirubin (TBIL), alanine aminotransferase (ALT) and aspartate aminotransferase (AST) in the two groups increased at first and then decreased after operation. The levels of TBIL, ALT and AST in the ablation group at 1, 3 and 7 days after operation were lower than those in the resection group contemporaneously (P<0.05). There were 2 cases (11.1%) of Clavien-Dindo grade Ⅰ-Ⅱ in the ablation group, 5 cases (19.2%) of grade Ⅰ-Ⅱ and 2 cases (7.7%) of grade Ⅲ-Ⅳ in the resection group, with no significant differences in the total incidence of postoperative complications and Clavien-Dindo grade between the two groups. In the ablation group, the cumulative 1, 3, 5-year tumor free survival rates were 94.4%, 65.2%, 34.2%, and the cumulative overall survival rates were 94.4%, 69.3%, 50.6%, respectively. In the resection group, the cumulative 1, 3, 5-year disease-free survival rates were 88.5%, 61.3%, 30.4%, and the cumulative overall survival rates were 92.3%, 65.5%, and 46.3%, respectively. There were no significant differences in the cumulative disease-free survival rate and cumulative overall survival rate between the two groups (χ²=0.030, P=0.862; χ²=0.067, P=0.796).

Ultrasound-guided RFA is safe and feasible for the treatment of hepatocellular carcinoma in the caudate lobe with diameter ≤ 5 cm, which can reduce the trauma of patients, accelerate the recovery of postoperative liver function, shorten the length of hospital stay, and the overall efficacy is similar to that of surgical resection.