Small HCC  

Although it is understood that partial resection assures the higher possibility to completely ablate the tumor, different comparative studies based on historical results (table 1).

Table 1

Survival curve of patients with cirrhosis with HCC less than 5 cm. Comparison among PEI, surgery and no treatment.	Survival curve of patients with Stage I disease having tumors ≤ 30 mm in size and ≤ 3 in number. RESC: resection; PEI: percutaneous ethanol injection; TAE: transcatheter arterial embolization.

and two prospective trials comparing surgery and PAT demonstrated roughly equivalent results (table 2).

In the second study the results were better with RFA when the size was < 3 cm, and better with surgery when the size was between 3 and 5 cm.
The explanation is probably due to a balance among advantages and disadvantages of the two therapies, the most important advantages of surgery being the higher ablation rate (using anatomical resection), and of PAT being repeatability, no loss or damage of nonneoplastic tissue and lower complication rate. Furthermore, the overall results of both therapies were partially flattened by the natural course of those aggressive tumors unresponsive to whatever treatment.
Currently, in our center, the selection for partial resection includes the following candidates (table 3).