Objective: The aim of this study was to compare the therapeutic efficacy of radiofrequency ablation (RFA) and surgical resection for the patients with hepatocellular carcinoma (HCC). Methods: From January 2002 to June 2009, 87 HCC patients with 3 or fewer nodules, no more than 3 cm in diameter, and liver function of Child-Pugh class A or B were enrolled.Forty-seven underwent RFA while 40 underwent surgical resection. Follow-up ranged from 6 to 69 months. We compared the overall and disease-free survival rate, recurrence patterns, and the complications between the two groups. Survival probabilities were estimated using the Kaplan-Meier method. Results: At the end of the study, 67 patients were alive. The 1-,2-and 3-year overall cumulative survival rates after RFA and surgical resection were 91.0%, 76.7%, 69.7% and 90.0%, 82.9%,75.4%, respectively. The difference between the two survival curves was not statistically significant (χ2 = 0.99, P = 0.32). Fortythree patients suffered intrahepatic recurrence, including 25 cases after RFA and 18 cases after surgical resection. The 1-,2-, and 3-year disease-free survival rates after radiofrequency ablation and surgical resection were 57.3% vs 71.1%, 40.3%vs 45.7%, and 35.3% vs 30.9%. The difference between the two groups was not statistically significant (χ2 = 0.06, P = 0.80).Cox hazard model indicated tumor size and Child-Pugh scoring were significant risk factors for local tumor progression, while tumor numbers was risk factor for intrahepatic distant recurrence. Conclusion: RFA is as effective as surgical resection for the treatment of patients with HCC (≤ 5 cm), especially for those who are not suitable for curative resection.