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 unclear. This study aimed to compare the clinical efficacy and safety between AR and parenchymal-sparing hepatectomy (PSH) for early-stage perihilar HCC. Methods: A total of 201 patients with perihilar HCC who underwent hepatectomy between January 2015 and December 2023 were retrospectively analyzed. 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. The survival outcomes and postoperative complications were compared 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), and the incidence of postoperative liver failure was also higher in the AR group than in the PSH group (14.3% vs 3.9%, P=0.025). The 1-, 3-, and 5-year overall survival (OS) rates were 94.6%, 80.4%, and 75.2% in the AR group and 97.4%, 78.5%, and 66.6% 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% in the AR group and 76.5%, 48.2% and 46.2% in the PSH group, respectively (P=0.415). OS and RFS rates were similar in both groups. Multivariate analysis revealed that AFP ≥400 ng/mL (P