The curative treatment modalities for hepatocellular carcinoma (HCC) include liver transplantation, surgical resection (SR), and radiofrequency ablation (RFA). Although liver transplantation is the best treatment option for patients with HCC, SR and RFA are most commonly considered first-line treatments because of the graft shortage. Numerous studies suggest both SR and RFA are comparable in terms of long-term survival for patients with early stage HCC. The 5-year survival rates are 42%–56% for SR and 42%–70% for RFA [1–6]. However, even in patients who underwent liver transplantation, tumor recurrence is not uncommon with a 10%–15% risk of recurrence . The 5-year recurrence rate after SR is 42%–52% [8–11], which is higher up to 42%–70% after RFA [12, 13]. Therefore, how to manage recurrent HCC is important in improving the survival and merits further evaluation. Of all the recurrence patterns, intrahepatic recurrence is the most common and the size of the recurring HCC is usually smaller than that of the initial HCC because the surveillance interval is shorter . Accordingly, the treatment options do not particularly differ between recurrent HCC after SR and primary tumor. Liver transplantation is still recognized as the better choice for recurrent HCC , but its wide application has been limited by the shortage of donors. Repeated SR for recurrent HCC has been reported to be an effective treatment option with a comparable survival rate to that of primary SR [16–18], but its feasibility is limited by small liver remnants, poor liver function reserve, or technical difficulties owing to expected postoperative adhesion [19–21]. RFA, as a nonsurgical, less invasive, and repeatable therapeutic approach, is safer and causes less damage in treating recurrent HCC following primary resection [22–24]. As to the choice of repeated SR and RFA, although several studies have compared the clinical outcome of RFA vs. SR for recurrent HCC, no clear recommendation has yet been established. Many of the studies were limited by small case numbers or large tumor size [25–31] and there remain many controversies regarding the choice of repeated SR and RFA in treating recurrent tumor after primary resection. This study aimed to compare the efficacy, safety, and long-term survival of repeated SR and RFA for recurrent HCCs.