Objective: To compare the efficacy of ultrasound guided percutaneous radiofrequency ablation (RFA) and laparoscopic hepatectomy in treatment of small primary cancer of the liver (diameter≤3 cm). Methods: The clinical data of 35 patients with small primary liver cancer undergoing ultrasound guided RFA (ablation group) from January 2012 to June 2015, and 30 patients undergoing laparoscopic hepatectomy (laparoscopic group) during the same period were retrospectively analyzed. The relevant surgical variables as well as the postoperative recurrence and survival rates between the two groups were compared. Results: In ablation group compared with laparoscopic group, the operative time (53.89 min vs. 128.57 min), intraoperative blood loss (7.29 mL vs. 115.33 mL), length of postoperative hospital stay (1.86 d vs. 5.50 d) and hospitalization cost (17 300 yuan vs. 22 300 yuan) were all significantly reduced (all P<0.05), while the changes in liver function parameters and incidence of postoperative complications had no statistical difference (all P>0.05). There was no significant difference in radical surgery rates (97.1% vs. 100.0%) and 3-year recurrence rates (51.4% vs. 40.0%) as well as 1-, 2- and 3-year disease-free survival rates (74.3% vs. 76.7%, 62.9% vs. 66.7%, 37.1% vs. 40.0%) and overall survival rates between ablation group and laparoscopic group (85.7% vs. 86.7%, 82.9% vs. 83.3%, 77.1% vs. 80.0%). Conclusion: RFA and laparoscopic hepatectomy have similar efficacy for small primary liver cancer. Therefore, RFA has the advantages of minimal invasiveness, shorter operative time and fast postperative recovery, so it has important clinical therapeutic value for small primary liver cancer.