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This study aimed to compare the efficacy and safety of RFA and VATS in patients with PHH. We recruited patients aged\u2009\u2265\u200914\u00a0years with diagnosed PHH from 14 centres in China. The treatment options of RFA or VATS were assigned to two cohort in patients with PHH. The primary outcome was the efficacy at 1-year. A total of 807 patients were enrolled. After propensity score matching, the rate of complete remission was lower in RFA group than VATS group (95% CI 0.21\u20130.57; <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001). However, the rates of palmar dryness (95% CI 0.38\u20130.92; <jats:italic>p<\/jats:italic>\u2009=\u20090.020), postoperative pain (95% CI 0.13\u20130.33; <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001), and surgery-related complications (95% CI 0.19\u20130.85; <jats:italic>p<\/jats:italic>\u2009=\u20090.020) were lower in RFA group than in VATS group, but skin temperature rise was more common in RFA group (95% CI 1.84\u20133.58; <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001). RFA had a lower success rate than VATS for the complete remission of PHH. 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