Background　and　Goals:Whether　radiofrequency　ablation　or　hepatic　resection　is　superior　for　improving　the　survival　in　patients　with　small　hepatocellular　carcinoma　(HCC)　remains　controversial.　A　meta-analysis　of　randomized　controlled　trials　was　performed　to　examine　this　issue.Methods:PubMed,　EMBASE,　and　Cochrane　Library　databases　were　used　to　identify　all　randomized　controlled　trials　comparing　the　survival　between　small　HCC　patients　receiving　radiofrequency　ablation　and　hepatic　resection.　The　hazard　ratio　(HR)　was　pooled　to　compare　the　overall　survival　and　recurrence-free　survival　rates.　The　odds　ratio　was　pooled　to　compare　the　incidence　of　treatment-related　complications.　The　mean　difference　was　pooled　to　compare　the　hospitalization　duration.　Heterogeneity　among　studies　was　assessed.Results:Three　randomized　controlled　trials　were　included　in　this　meta-analysis.　All　patients　met　the　Milan　criteria.　Hepatic　resection　was　superior　to　radiofrequency　ablation　for　the　improvement　of　overall　survival　[HR=1.41;　95%　confidence　interval　(CI),　1.06-1.89;　P=0.02]　and　recurrence-free　survival　(HR=1.41;　95%　CI,　1.14-1.74;　P=0.001).　Heterogeneity　among　studies　was　not　significant　(overall　survival:　P=0.14;　recurrence-free　survival:　P=0.28).　Patients　treated　with　hepatic　resection　had　a　significantly　higher　incidence　of　treatment-related　complications　(odds　ratio=0.12;　95%　CI,　0.03-0.47;　P=0.002)　and　a　significantly　longer　hospitalization　duration　(mean　difference:　-8.77;　95%　CI,　-10.36　to　-7.18;　P＜0.00001)　than　those　treated　with　radiofrequency　ablation.　Heterogeneity　among　studies　was　significant　(treatment-related　complications:　P=0.006;　hospitalization　duration:　P=0.003).　No　hospital　death　occurred　in　the　2　groups.Conclusions:Evidence　from　the　meta-analysis　of　randomized　controlled　trials　suggested　that　hepatic　resection　might　improve　the　overall　survival　and　recurrence-free　survival　in　small　HCC　patients,　whereas　increase　the　complications　and　hospitalization　duration.　However,　this　conclusion　should　be　explained　with　caution,　due　to　the　absence　of　further　subgroup　analysis　with　respect　to　the　outcome　in　patients　with　different　tumor　size　(＜3　and　3　to　5　cm).