No-touch versus conventional radiofrequency ablation for treating solitary recurrent hepatocellular carcinoma ≤ 3 cm: a retrospective cohort study

This study aimed to compare the outcomes of no-touch radiofrequency ablation (NT-RFA) and conventional RFA (C-RFA) in the treatment of solitary recurrent hepatocellular carcinoma (rHCC) ≤ 3 cm. 255 patients with rHCC treated with RFA in our center from January 2017 to December 2023 were retrospectively analyzed (NT-RFA: 63, C-RFA: 192 patients). Short- and long-term outcomes were compared, and survival rates were calculated. The ablation range and safety margin differed significantly between the two groups (both p < 0.01). The 1-, 3-, and 5- years overall survival (OS) rates were 96.83%, 75.51% and 45.61% respectively in the NT-RFA group, while 97.39%, 77.48% and 48.56% in the C-RFA group, with no significant difference between the two groups (P = 0.510). The 1-, 3-, and 5-year recurrence-free survival (RFS) rates in the NT-RFA group were 73.02%, 46.22% and 36.77%, respectively, while 69.70%, 38.95% and 27.78% in the C-RFA group, with no significant difference between the two groups (P = 0.338). The 1-, 3-, 5-year local tumor progression (LTP) free survival rates in the NT-RFA and C-RFA group were 84.13%, 67.04%, 67.04% and 78.02%, 53.70%, 48.80% respectively, with significant difference between the two groups (P = 0.047). However, there was no significant difference in intrahepatic distant recurrence free survival rates between the two groups (P = 0.068). NT-RFA treatment for rHCC ≤ 3 cm is as safe as C-RFA, but it achieves a larger ablation range and safety margin. Although NT-RFA does not significantly improve RFS or OS in rHCC ≤ 3 cm, it significantly reduces the LTP.