Objective To compare clinical efficacy and recurrence between surgical resection and radiofrequency ablation (RFA) in the treatment of small hepatocellular carcinoma (HCC) .Methods The clinical data of 97 patients with small HCC, who underwent surgical resection or RFA as the initial treatment in The First Hospital of Jilin University from January 2002 to December 2008, were collected.Sixty-three cases, who survived 2 years after treatment, were followed up;of the 63 cases, 34 underwent surgical resection, and 29 underwent RFA.The recurrence of these patients was analyzed retrospectively.The measurement data were analyzed by chi-square test.The Cox regression analysis was used for determining the risk factors for recurrence.The log-rank test was used for disease-free survival (DFS) difference analysis.Results The 3-month, 1-year, and 2-year intrahepatic recurrence rates for the patients who underwent surgical resection were 15%, 38%, and 64%, respectively, versus 21%, 35%, and 45% for those who underwent RFA, without significant differences between the two groups of patients.The intrahepatic recurrence after initial treatment was not significantly associated with treatment method, sex, age, Child-Pugh grade, tumor size, number of nodules, presence of cirrhosis, and alpha-fetoprotein level.There was no significant difference in DFS between the two groups of patients.Conclusion RFA produces a comparable outcome to that by surgical resection in the treatment of small HCC.RFA holds promise as a substitute for surgical resection.