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HOME > J Liver Cancer > Volume 24(1); 2024 > Article
Reply to the Letter regarding “Treatment options for solitary hepatocellular carcinoma ≤5 cm: surgery vs. ablation: a multicenter retrospective study”
Kazuhiro Nousoorcid, Kazuya Kariyamaorcid
Journal of Liver Cancer 2024;24(1):5-6.
Published online: January 19, 2024

Department of Gastroenterology, Okayama City Hospital, Okayama, Japan

Corresponding author: Kazuhiro Nouso, Department of Gastroenterology, Okayama City Hospital, 3-20-1 Kitanagase-Omotemachi, Kita-ku, Okayama 700-8557, Japan E-mail:
• Received: December 19, 2023   • Accepted: January 2, 2024

© 2024 The Korean Liver Cancer Association.

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Dear Editor,
In our recent retrospective study, we investigated the efficacy of ablation therapy in treating solitary hepatocellular carcinoma (HCC) with a diameter of ≤5 cm.1 Our findings suggest that ablation can be a viable alternative to surgery, particularly for cases where the HCC is no larger than 3 cm. When comparing the outcomes for HCCs measuring 3-5 cm, overall survival did not differ significantly between ablation and surgery. However, surgery demonstrated superior recurrence-free survival compared to ablation in this specific size range.
Dr. Kim, in a recent letter to the editor, emphasized the necessity for a well-designed randomized controlled study to comprehensively assess the effectiveness of ablation and surgery in treating solitary HCC of various sizes. Acknowledging the multitude of factors influencing treatment effectiveness, Dr. Kim pointed out the limitations of existing randomized controlled trials (RCTs) in providing detailed insights into the efficacy within specific populations.
We share Dr. Kim's perspective, particularly regarding the importance of an RCT focusing on the effectiveness of surgery and ablation for solitary HCC measuring 3-5 cm. While subgroup analyses of existing RCTs within Milan criteria did not reveal significant differences in overall survival or progression-free survival for solitary HCC measuring 3-5 cm,2 this information falls short in guiding precise treatment selection in specific scenarios. An in-depth analysis considering factors such as age, patient comorbidity, and tumor location is crucial.
A forthcoming large-scale RCT, with a specific focus on solitary HCC measuring 3-5 cm, should incorporate subgroup analyses that explore factors influencing treatment selection. Such analyses would provide valuable insights into optimal treatment choices based on individual patient backgrounds. Despite the need for further research, our study results suggest that clinicians, by considering patient backgrounds, have been adept at selecting appropriate treatments, as evidenced by the absence of significant differences in overall survival between ablation and surgery in our study.

Conflict of Interest

Kazuhiro Nouso is an editorial board member of Journal of Liver Cancer, and was not involved in the review process of this article. Otherwise, the authors have no conflicts of interest to disclose.

Ethics Statement

Not applicable.

Funding Statement


Data Availability

Not applicable.

Author Contribution

Writing - original draft: KN

Writing - review & editing: KN, KK

  • 1. Kariyama K, Nouso K, Hiraoka A, Toyoda H, Tada T, Tsuji K, et al. Treatment options for solitary hepatocellular carcinoma ≤5 cm: surgery vs ablation: a multicenter retrospective study. J Liver Cancer 2023;Nov 6 doi: 10.17998/jlc.2023.09.11. [Epub ahead of print].
  • 2. Ng KKC, Chok KSH, Chan ACY, Cheung TT, Wong TCL, Fung JYY, et al. Randomized clinical trial of hepatic resection versus radiofrequency ablation for early-stage hepatocellular carcinoma. Br J Surg 2017;104:1775−1784.ArticlePubMedPDF

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        Reply to the Letter regarding “Treatment options for solitary hepatocellular carcinoma ≤5 cm: surgery vs. ablation: a multicenter retrospective study”
        J Liver Cancer. 2024;24(1):5-6.   Published online January 19, 2024
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