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Updated: Jul 11, 2026
The Influence of Liver Resection on Intrahepatic Tumor Growth
Published on: April 9, 2016
Achieving textbook outcome in liver resection for hepatocellular carcinoma: malnutrition's pivotal role
Kentaro Oji1, Takeshi Urade2, Satoshi Omiya1
1Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery, Kobe University Graduate School of Medicine, Kobe University, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan.
Insights
Achieving textbook outcomes (TO) after liver resection for hepatocellular carcinoma (HCC) significantly improves patient survival. Malnutrition and other factors influence TO achievement, highlighting its role in treatment quality assessment.
Area of Science:
- Hepatobiliary Surgery
- Surgical Oncology
- Gastroenterology
Background:
- Hepatocellular carcinoma (HCC) is a major global health concern.
- Liver resection is a primary curative treatment for HCC.
- Assessing treatment quality and patient outcomes is crucial in HCC management.
Purpose of the Study:
- To evaluate the impact of textbook outcome (TO) achievement on survival after liver resection for HCC.
- To identify factors associated with achieving TOs in HCC patients undergoing liver resection.
Main Methods:
- Retrospective review of 330 HCC patients who underwent initial liver resection.
- Analysis of five predefined TOs and their relationship with patient malnutrition.
- Nutritional status assessment using the Global Leadership Initiative on Malnutrition (GLIM) criteria.
Main Results:
- The overall TO achievement rate was 72.7%.
- Patients achieving TOs demonstrated significantly longer overall survival (OS) and recurrence-free survival (RFS).
- Factors including age, BMI, weight loss, muscle mass, liver function tests, tumor characteristics, blood loss, transfusion, and nutritional status differed between groups.
Conclusions:
- TO achievement is a significant predictor of improved OS and RFS post-liver resection for HCC.
- TOs serve as a valuable metric for evaluating the quality of liver resection treatment.
- Malnutrition (GLIM criteria), age, tumor stage, and intraoperative blood loss are independent predictors for achieving TOs.
Purpose:
To investigate the impact of textbook outcome (TO) achievement on survival post-liver resection for hepatocellular carcinoma (HCC) and explore the associated factors.
Methods:
We retrospectively reviewed 330 patients diagnosed with HCC who underwent initial liver resection at our hospital between January 2011 and December 2019. We also investigated the achievement rates of five TOs and sub-analyzed the relationship between them and malnutrition. The patient's nutritional status was classified following the Global Leadership Initiative on Malnutrition (GLIM) criteria.
Results:
The TO achievement rate was 72.7%. In the prognostic analysis, the TO-achieving group showed significantly longer overall survival (OS) and recurrence-free survival (RFS). Significant differences in age, body mass index, weight loss, muscle mass, serum aspartate aminotransferase level, serum protein induced by vitamin K absence or antagonist-II, tumor characteristics, intraoperative blood loss, perioperative transfusion, and nutritional status were found between the groups.
Conclusions:
TO achievement is associated with OS and RFS post-liver resection for HCC. The TO is valuable for evaluating treatment quality in liver resection. Additionally, malnutrition graded following the GLIM criteria, age, tumor stage, and intraoperative blood loss are independent factors for achieving a TO post-liver resection for HCC.
