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Background An updated systematic review and meta‐analysis was conducted to compare radiofrequency ablation (RFA) versus repeat hepatectomy (RH) for patients with recurrent hepatocellular carcinoma (rHCC) after a previous liver resection. Methods PubMed, EMBASE, and Cochrane databases were searched from inception to October 2021 for randomized controlled trials and propensity‐score matched studies. Individual participant survival data of disease‐free survival (DFS) and overall survival (OS) were extracted and reconstructed followed by one‐stage and two‐stage meta‐analysis. Secondary outcomes were major complications and length of hospital stay (LOHS). Results A total of seven studies (1317 patients) were analysed. In both one‐stage and two‐stage meta‐analysis, there was no significant difference in OS between the RFA and RH cohorts (Hazard Ratio (HR) 1.15, 95% CI 0.98–1.36, P = 0.094 and HR 1.12, 95% CI 0.77–1.64, P = 0.474 respectively), while the RFA group had a higher hazard rate of disease recurrence compared to the RH group (HR 1.30, 95% CI 1.13–1.50, P < 0.001 and HR 1.31, 95% CI 1.09–1.57, P = 0.013, respectively). RFA was associated with fewer major complications and shorter LOHS versus RH (Odds Ratio 0.34, 95% CI 0.15–0.76, P = 0.009 and Weighted Mean Difference − 4.78, 95% CI − 6.30 to − 3.26, P < 0.001, respectively). Conclusions RH may be associated with superior DFS for rHCC, at the expense of higher morbidity rate and longer LOHS. However, OS is comparable between both modalities. As such, these techniques may be utilized as complementary strategies depending on individual patient and disease factors. Large‐scale, randomized, prospective studies are required to corroborate these findings.

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