Impact of major versus minor hepatectomy on long-term outcomes for solitary hepatocellular carcinoma

Background: The extent of liver resection (LR), major hepatectomy (MAH) or minor hepatectomy (MIH), is an important factor for surgical planning of solitary hepatocellular carcinoma (HCC). Their impacts on long-term outcomes are under debate. We aim to evaluate the impacts of MAH or MIH on long-term outcomes for solitary HCC. Moreover, their effects are evaluated in subgroup analyses based on two factors: tumor size (>5 cm/≤5 cm) and LR type (anatomical resection/nonanatomical resection, AR/NAR). Materials and methods: In this retrospective cohort study, 1773 patients were assessed from January 2009 to December 2017. With the inclusion criteria of Child–Pugh A or B, without macrovascular invasion and bile duct invasion, 1496 patients were included: 329 received MAH and 1167 received MIH. Propensity score matching (PSM) with 1:1 ratio was used to eliminate the selection bias. Results: After PSM, 304 patients were in the MAH or MIH group, respectively. Through Kaplan–Meier analyses, MIH had better overall survival (OS) and disease-free survival (DFS) than MAH. Through univariate and multivariate Cox analyses, MAH was an independent risk factor of poor OS and DFS. In subgroup analyses, MIH had better DFS than MAH in the NAR subgroup, but had comparable DFS with MAH in the AR subgroup. MIH had better DFS than MAH for tumor >5 cm, but had comparable DFS with MAH for tumor ≤5 cm. MIH had better OS compared with MAH in all four subgroup analyses. Conclusion: Regardless of the tumor size and LR type, MIH was preferred than MAH for solitary HCC because of the better long-term outcomes.