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Background: Despite its benign nature, hepatocellular adenomas (HA) have a potential for malignant degeneration or spontaneous rupture and bleeding. Surgical resection has been the treatment of choice for the management of HA in selected patients. However, radiofrequency ablation (RFA) could offer a viable alternative, and might prevent these patients from undergoing major hepatic surgery with associated morbidity and costs.Objective: To investigate the safety and efficacy of RFA for the treatment of HAMethods: From 2000 to 2009, 168 patients diagnosed with HA in a tertiary hepato-biliary centre were included in a database. Medical records of patients undergoing RFA were retrieved and clinicopathologic data with regard to diagnosis, treatment and outcome were collected and analyzed. RFA was considered successful if no residual HA tissue could be visualized on contrast enhanced CT or MRI scan 4-6 weeks post-RFA.Results: Of 61 patients undergoing treatment for HA, 17 patients (28%) underwent RFA for HA. Mean age was 29 years. All patients were female and had a history of hormonal contraceptive use, which was discontinued at the time of diagnosis. Nine patients (53%) had multiple HA, with a median number of 2 lesions (range 1-10) per patient. Median size of the largest HA at the time of diagnosis was 4.3 cm (range 2.3-14.0) and median size of the largest HA at the time of RFA was 3.9 cm (range 1.5-6.7). A total of 39 lesions were ablated in 25 sessions (open n=5, percutaneous n=20). RFA was successful at the first attempt in 4 patients (24%). Seven patients underwent additional sessions of RFA resulting in adequate treatment in 4 patients (24%). Five patients (29%) had radiological evidence of small residual HA tissue (≤15 mm) bordering the thermal lesion, but due to low clinical importance no further treatment was administered. All of these lesions have remained stable or regressed during follow-up. Four patients are currently awaiting further therapy or follow-up. Post-operatively, one patient developed a liver abscess requiring re-intervention and one patient suffered from a major but reversible complication related to concomitant hemi-hepatectomy. Median hospital stay was 7 days in the open group and 2 days in the percutaneous group. Conclusion: HA can be safely treated using both open and percutaneous RFA. However, multiple sessions are often required and signs of residual adenoma might persist in some patients despite repetitive treatment. RFA might be especially beneficial for patients not amenable for surgery or those that would require major hepatic resection otherwise.