The improvement in liver function evaluation, surgical technique and perioperative care and decrease in postoperative morbidity and mortality make it possible for more patients to receive surgical resection [16, 35, 36]. However, surgical resection of recurrent HCC is still challenging due to small liver remnants, poor liver function reserve, intra-abdominal adhesion from previous surgery, and the tumor location being adjacent to major vascular or biliary structures. Although the latest literatures suggest repeated SR is considered a favorable and important curative treatment for recurrent HCC, postoperative complications, and in particular hepatic failure, are not uncommon and can not be overlooked . A meta-analysis study showed repeated SR for recurrent HCC was associated with a higher procedure related morbidity rate compared with RFA . Our study showed the procedure-related complication rates were higher in the repeated SR group than that in the RFA group (16% vs. 7% p = 0.14). One patient with repeated SR had major complications and died of bile duct injury with bile leakage and septic shock. RFA is a minimally invasive procedure and can be performed percutaneously either by ultrasound or CT guided approach. Compared with repeated SR via the open or laparoscopic approach, RFA is a highly target-selective thermal treatment technique to conserve non-tumorous liver parenchyma and minimize the degree of surgical insult to the limited liver reserve. Apart from surgery, RFA can be performed under conscious sedation and has a shorter hospital day, making it more cost-effective than surgical resection [2, 38]. In our study, median total hospital stay for patients who underwent RFA was significantly shorter than for those who underwent repeated SR (5 vs. 13 days, p < 0.05). Further, the characteristics and benefits of less invasiveness and highly-targeted tumor treatment improved the feasibility of patients and repeatability of RFA for recurrent HCC. Our study showed more than one third of patients in both groups underwent loco-regional treatment for a second recurrence of HCC, whereas 8% of patients in the RFA group and 27% of patients in the repeated SR group were amenable to surgical resection of a second recurrence of HCC. The aforementioned beneficial factors of RFA make it more safe and feasible in treating recurrent HCC after hepatectomy.