Analysis of the efficacy and safety of parenchymal-sparing anatomical hepatectomy: A propensity score-matched study

Radical surgical resection is the most crucial approach for achieving long-term survival in patients with liver cancer. Previous studies have indicated that anatomical hepatectomy yields better survival outcomes. Anatomical hepatectomy can be further divided into formal anatomical hepatectomy (FAH) and parenchymal-sparing anatomical hepatectomy (PSAH). This study aims to compare the survival outcomes and safety of these two surgical techniques in patients with hepatocellular carcinoma (HCC). Clinical data of HCC patients who underwent FAH or PSAH at the University of Hong Kong Shenzhen Hospital from 2013 to 2021 were retrospectively collected. Patients were categorized into the FAH group or the PSAH group based on the specific surgical procedure received. Propensity score matching (PSM) was performed to balance the baseline characteristics of the two groups. The baseline demographic and tumor characteristics, surgical characteristics, and survival outcomes of both groups were compared. A total of 140 HCC patients were included in the study. After PSM, 75 patients were successfully matched, with 46 in the PSAH group and 29 in the FAH group. Prior to matching, the PSAH group demonstrated significantly smaller maximum tumor diameter (4.2 vs. 7.0 cm, P < 0.001) and lower tumor burden score (4.6 vs. 7.3, P < 0.001), as well as fewer patients with macrovascular invasion (2 % vs. 12.5 %, P = 0.032) and microvascular invasion (38 % vs. 60 %, P = 0.029). No significant differences were observed in surgical characteristics between the groups before matching. After matching, the baseline demographic and tumor characteristics were well-balanced between the two groups, and no significant differences were observed in surgical characteristics. Survival analysis indicated that both before and after matching, the PSAH group showed significantly better disease-free survival (DFS; P < 0.001, P = 0.028) and overall survival (OS; P < 0.001, P = 0.029) compared to the FAH group. After balancing the key prognostic factors affecting patient outcomes, it was found that patients undergoing PSAH exhibited better survival results without an increase in perioperative complications. When both surgical options are available and conditions permit, PSAH should be prioritized.