Impact of major hepatectomy on recurrence after resection of hepatocellular carcinoma at CNLC Ib stage: a propensity score matching study

Objective: Patients with hepatocellular carcinoma (HCC) who undergo curative hepatectomy may experience varying remnant liver volumes. Our study aimed to evaluate whether the extent of liver resection has an effect on postoperative recurrence in HCC patients at China Liver Cancer Staging (CNLC) Ib stage. Methods: A retrospective analysis was conducted on 197 patients who underwent hepatectomy for a solitary HCC lesion measuring >= 5 cm (CNLC Iota b stage) between January 2019 and June 2022. Patients were divided into a major hepatectomy (MAH) group (n=70) and a minor hepatectomy (MIH) group (n=127) based on the extent of liver resection. Recurrence-free survival (RFS) was compared between the two groups. Propensity score matching (PSM) was employed to minimize bias in the retrospective analysis. Results: Patients who underwent MAH had a greater total complication rate than those who underwent MIH (35.7 vs. 11.8%, P<0.001). The median RFS was 14.6 months (95% CI: 11.1-18.1) for the MAH group and 24.1 months (95% CI: 21.2-27.1) for the MIH group (P<0.001). After PSM, patients who underwent MAH still had a greater total complication rate than those who underwent MIH (36.7 vs. 16.3%, P=0.037). The median RFS was 13.2 months (95% CI: 15.1-21.7) for the MAH group and 22.3 months (95% CI: 18.1-26.5) for the MIH group (P=0.0013). The Cox regression model identified MAH as an independent poor predictor for HCC recurrence (hazard ratios of 1.826 and 2.062 before and after PSM, respectively; both P<0.05). Conclusion: MIH can be performed with fewer postoperative complications and contributes to improved RFS in patients with HCC at CNLC Iota b stage compared to MAH. Parenchyma-sparing resection should be considered the first choice for these HCCs.