Objective: To compare the efficacy and safety of radiofrequency ablation (RFA) and surgical re-resection (SRR) in treatment of recurrent hepatocellular carcinoma (HCC) within the Milan Criteria. Methods: The clinical controlled studies comparing RFA and SRR in treatment of postoperative recurrent HCC published between January 2000 and January 2017 were collected by searching from national and international databases. The data from eligible studies were analyzed by Revman5.3 software. Results: Eleven clinical studies were included involving 1 079 patients, of whom, 560 cases underwent RFA (RFA group) and 519 underwent SRR (SRR group). The results of Meta-analysis showed that there was no significant difference in postoperative 1-, 3- and 5-year survival rates between the two groups (all P>0.05), but the incidence of postoperative complications was decreased (OR=0.25, 95% CI=0.14–0.44, P<0.00001) and the length of hospital stay was shortened (OR=–6.57, 95% CI=–7.74--4.09, P<0.00001) in RFA group compared with SRR group, while the 3-year recurrence-free survival in SRR group was superior to that in RFA group (OR=0.60, 95% CI=0.42–0.86, P=0.006). Conclusion: There is no significant efficacy difference between the two methods in treatment of postoperative recurrent HCC within the Milan Criteria, while RFA possesses the advantages of minimal invasiveness, repeatable operation and high safety level.