Anatomical versus parenchymal-sparing hepatectomy for early-stage perihilar hepatocellular carcinoma: A propensity score matching analysis

Background: The benefit of anatomical hepatectomy (AR) for patients with early-stage perihilar hepatocellular carcinoma (HCC) remains unknown. The aim of this study was to compare the clinical efficacy and safety of AR and parenchymal-sparing hepatectomy (PSH) for early-stage perihilar HCC. Methods: This study retrospectively analyzed 201 perihilar HCC patients who underwent hepatectomy between January 2015 and December 2023. Among them, 114 patients received AR, and 87 patients received PSH. Propensity score matching (PSM) with a 1:1 ratio was used to eliminate selection bias and to compare the survival outcomes and postoperative complications between the two groups. Results: After PSM, 77 patients were included in each group. The proportion of patients with surgical margins ≥1 cm was higher in the AR group (31.2% vs. 11.7%, P=0.003). The 1-, 3-, and 5-year overall survival (OS) rates were 94.6%, 80.4%, and 75.2%, respectively, in the AR group and 97.4%, 78.5%, and 66.6%, respectively, in the PSH group (P=0.292). The 1-, 3-, and 5-year recurrence-free survival (RFS) rates were 76.5%, 59.2% and 50.5%, respectively,in the AR group and 76.5%, 48.2% and 46.2%, respectively,in the PSH group (P=0.415). Multivariate analysis revealedthat AFP ≥400 ng/mL (P<0.001), the serum ALB level (P=0.024), the tumor diameter (P=0.012), the presence of satellite nodules (P=0.006), and overall postoperative complications (P=0.005) were independent risk factors for OS. Viral hepatitis (P=0.012), AFP ≥400 ng/mL (P=0.002), the presence of satellite nodes (P=0.031), and postoperative adjuvant therapy (P=0.028) were independent risk factors for RFS. Conclusions: PSH provided long-term survival outcomes comparable to those of AR. PSH is a safe and feasible treatment option for patients with early-stage perihilar HCC.