Surgical Resection vs. Percutaneous Ablation for Single Hepatocellular Carcinoma: Exploring the Impact of Li-RADS Classification on Oncological Outcomes

Li-RADS classification has recently emerged as an accurate tool for hepatocellular carcinoma diagnosis in the setting of liver cirrhosis, but its prognostic value has never been investi- gated so far. Single HCC benefits from both surgical resection and percutaneous ablation, although several studies support the superiority of surgery in terms of oncological results. We retrospectively and blindly classified 140 treatment-naïve single HCC according to Li-RADS protocol, comparing the oncological outcomes of surgical resection and percutaneous ablation for each Li-RADS subclass. Our analysis highlighted better overall survival, recurrence free survival and lower incidence of local recurrence after surgical resection in Li-RADS-5 nodules, while Li-RADS-3/4 subclasses showed similar outcomes after the two treatments. These results confirm the superiority of surgical approach for single HCC and suggest a potential prognostic role of Li-RADS classification, supporting liver resection especially for Li-RADS-5 subclass.