Background and Aims: Radiofrequency ablation (RFA) and laparoscopic hepatectomy are important treatment modalities for small hepatocellular carcinoma (HCC), and both method have their indications, advantages and limitations, which also are the main themes addressed by existing literature. However, there are relatively scarce data regarding the short-term efficacy especially the health economic costs of the two methods. Therefore, this study was conducted to determine the differences in short-term efficacy outcomes and medical costs between percutaneous RFA and laparoscopic hepatectomy in treatment of small HCC, so as to provide help for the selection of treatment options for small HCC in clinical practice.  
Methods: The clinical data of 80 patients with small HCC (tumor diameter ≤5 cm) treated from August 2017 to July 2019 were retrospectively analyzed. Of the patients, 40 cases underwent percutaneous RFA (RFA group) and the other 40 cases underwent laparoscopic hepatectomy (laparoscopic group). The main clinical variables and medical costs were compared between the two groups of patients. 
Results: There were no signi?cant differences in preoperative baseline data and levels of liver function parameters and α-fetoprotein (AFP) between the two groups (all P>0.05). The liver function parameters were initially increased and then decreased in RFA group, and were continuously declined laparoscopic group after operation. The liver fuction parameters on postopertive 3 d were significantly higher in RFA group than those in laparoscopic group[ALT: (65.72±25.61) U/L vs. (45.26±23.36) U/L, AST: (77.27±12.51) U/L vs. (53.29±11.24) U/L, TBIL: (25.12±6.06) μmol/L vs. (22.26±4.39) μmol/L, all P<0.05] , but showed no significant differences on postoperative one month between the two groups (all P>0.05). The AFP levels were gradually reduced in both groups after operation, which showed no signi?cant differences between the two groups in the same time points (both P>0.05). The operative time, intraoperative blood loss, length of hospital stay and incidence of postoperative complications in RFA group were signi?cantly less than those in laparoscopic group[(62.6±11.7) min vs. (155.2±27.5) min, (5.2±0.5) mL vs. (76.2±11.3) mL, (4.3±1.2) d vs. (6.3±1.8) d, 5.0% vs. 17.5%, all P<0.05] . The tumor removal rates were 100% in both groups. In the direct medical cost components, the costs for surgery-related care, medications and hospitalization in RFA group were significantly lower than those in laparoscopic group[(11 526.46±941.08) yuan vs. (14 277.25±938.46) yuan, (1 825.33±179.5) yuan vs. (2 614.19±222.4) yuan, (476.30±67.71) yuan vs. (712.03±87.52) yuan, allP<0.05] , but no significant differences were noted in the testing and examination and other costs between the two groups (both P>0.05); the direct and indirect medical costs as well as the total medical costs in RFA group were significant lower than those in laparoscopic group[(17 446.78±1 465.24) yuan vs. (21 270.62±1 612.38) yuan, (782.23±66.80) yuan vs. (1 654.67±120.47) yuan, (18 228.01±1 539.72) yuan vs. (22 924.35±1922.67) yuan, all P<0.05] .
Conclusion: RFA and laparoscopic hepatectomy have similar the short-term efficacy in treatment of small HCC. However, RFA is associated with shortened operative time and hospital stay as well as decreased incidence of postoperative complications, so the direct and total medical costs incurred by RFA are aslo lower than those by laparoscopic hepatectomy.