Hepatocellular carcinoma (HCC) is prevalent in Southeast Asia and sub-Saharan Africa.1 With the widespread use of alpha fetoprotein (AFP), ultrasound, and other diagnostic modalities as screening tools, many small HCC tumors are detected before symptoms develop and are treated effectively.2,3 Surgical resection is considered the standard treatment of small HCCs, and results have been promising.4 Initially, percutaneous ethanol injection therapy (PEIT) was considered an alternative treatment of patients with small HCC and poor liver reserve for whom resection posed the risk of liver failure. However, several studies have shown similar or even better results with PEIT than with surgical resection.5–7 In Taiwan, HCC is the leading cause of cancer mortality. Many small HCCs are detected by surveillance, and routine surveillance of at-risk groups has been common in daily practice for at least a decade.2,3 Resection and PEIT are both widely used for the treatment of small HCCs,4,8 and the Taiwan National Health Insurance covers both treatments. Because the existing literature does not contain objective comparisons of these 2 treatment modalities9 and a prospective randomized comparative trial has been suggested repeatedly,9–11 we performed a randomized study comparing surgicalresection with PEIT for the treatment of small HCC.
