A Comparative Study of Surgical Approaches for Hepatocellular Carcinoma: Conversion versus Direct Resection

Xinlin Li,1 Kai Chen,1 Xu Feng,1 Xinhua Wu,1 Shiguai Qi,1 Qingmiao Wang,2 Zhengrong Shi1 1Department of Hepatobiliary Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, Chongqing, People’s Republic of China; 2Department of Obstetrics and Gynecology, The Fifth People’s Hospital of Chongqing, Chongqing, Chongqing, People’s Republic of ChinaCorrespondence: Zhengrong Shi, Email [email protected]: The purpose of This study is exploring the intraoperative and perioperative differences between patients undergoing conversion surgery and those undergoing direct surgery, so as to improve preoperative preparation.Methods: The retrospective study was approved by an ethics review committee. A total of 232 patients with hepatocellular carcinoma who underwent surgical resection at the First Affiliated Hospital of Chongqing Medical University from September 2022 to December 2023 were included, comprising 210 operating patients and 53 conversion patients. Propensity score matching was employed for comparison in order to minimize bias.Results: The conversion group had more intraoperative bleeding (each P=0.001), longer operation time (P=0.033; PSM p=0.025), and higher intraoperative blood transfusion rate (p=0.001; PSM p=0.044). The incidence of perioperative complications, including perioperative ascites formation (p=0.011; PSM p=0.005), moderate to severe anemia (p=0.001; PSM p=0.002), postoperative blood transfusion (p=0.004; PSM p=0.036), and postoperative ICU transfer (p=0.041; PSM p=0.025), was higher in the conversion group compared to the operation group. The postoperative hospital stay (p=0.001; PSM p=0.003) was prolonged in the conversion group.Conclusion: Post-conversion operations carry a higher risk of bleeding and are more likely to result in moderate to severe anemia and ascites formation in the perioperative period. However, the risk is reversible with adequate preoperative blood preparation and prompt postoperative symptomatic treatment. Conversion patients should be encouraged to undergo operating therapy when they can withstand surgical resection.Keywords: conversion therapy, hepatocellular carcinoma, perioperative complications, hepatectomy, perioperative complications