Minor resection for primary hepatocellular carcinoma promotes curative recurrent treatments

The extent of primary hepatectomy for hepatocellular carcinoma (HCC) may influence long-term outcomes, especially at recurrence. We investigated whether initial minor or major hepatectomy impacts retreatment options and survival following recurrence.

We retrospectively reviewed patients with primary HCC who underwent either initial major or minor hepatectomy. Outcomes analyzed included overall survival (OS), and post-recurrence overall survival (OS-R). Prognostic factors were analyzed using propensity score matching (PSM).

Among 1836 patients experienced recurrence, 873 matched cases were analyzed post-PSM. The crude 5-, 10-, and 15-year OS rates were 86.5 %, 73.9 %, and 61.5 %, respectively, in the minor hepatectomy group, and 76.8 %, 67.6 %, and 62.7 %, respectively, in the major hepatectomy group (p < 0.001). OS-R was comparable between the two groups among the matched cases. The prognostic factors for OS-R included the initial cancer stage, recurrent albumin-bilirubin score, recurrence with vascular invasion or extrahepatic metastases, and the selected recurrent treatment. More patients after primary minor hepatectomy underwent re-resection or local ablation as recurrent treatment, and were able to achieve better outcomes.

While recurrence rates and post-recurrence survival were similar between groups, minor hepatectomy may preserve greater liver volume, enabling more patients to receive further curative treatments upon recurrence. Minor hepatectomy offers better retreatment options and potentially better long-term survival.