2 A consideration prevailed: despite its immaterial nature (implicit in decision analysis) and the lack of multidisciplinary input (that we regret), the study offered the soundest comparison between RFTA and resection that is realistic to hope for. HCC, hepatocellular carcinoma; RCT, randomized controlled trial; RFTA, radiofrequency thermal ablation. Since their introduction, ablative techniques have challenged the supremacy of surgical resection for early HCC, more from the results of well-conducted observational studies with sufficient follow-up than from randomized controlled trials (RCTs), which are very difficult to organize. The LEE011 clinical trial efficacy

of optimal percutaneous ethanol injection was obviously very similar to the one of optimal surgical resection.3, 4 RFTA then arrived on the scene, with studies showing that the risks of seeding were essentially linked to unselected PS-341 ic50 indications,5 a

RCT proving RFTA’s supremacy to percutaneous ethanol injection,6 and more recent studies providing a data on intermediate-term results.7 In current practice, however, many surgeons still resist, moved sometimes by genuine concern about cases inappropriate for ablation, but often by reluctance to change, and by more selfish fears of dwindling referrals and loss of control. Does the study by Cho et al. give the final word on the equivalence between RFTA and resection? For the group of patients presenting with find more Child A cirrhosis and a very early HCC (some 5% of total referrals for HCC, at present), and probably for larger ones where RFTA can be optimally effective (HCC <3 cm), we believe so. However, while submitting this point of view, we will take the opportunity to share some comments on the choice between resection and its alternatives. The average results of liver resection and ablation for patients perfectly

suitable to each procedure are very similar in terms of overall survival. We should no longer ignore this fact simply because RCTs are missing, and the study by Cho et al., which was constructed taking into account the best scenarios for resection and the worst scenarios for ablation, although limited to HCC up to 2 cm, supports this statement. (A word of caution: the radiological literature needs to be as thorough as the surgical one in confirming that the good results of pioneers, serving as assumptions in the study, can be generalized). Individual components belonging to each patient nuance the picture, because they influence the results of each treatment making it better or worse than average (e.g., whether the tumor is central or peripheral, close or distant from bile ducts, in a patient who is lean or overweight, presenting with or without portal hypertension, etc.).