The impact of neoadjuvant therapy on postoperative outcomes in patients undergoing hepatectomies for hepatocellular carcinoma.

[BACKGROUND] Hepatocellular carcinoma (HCC) treatment is evolving rapidly with systemic/locoregional therapies which increase surgical options. This study explores whether neoadjuvant therapies affect early surgical outcomes.

[METHODS] National Surgical Quality Improvement Program (NSQIP) database was used to identify patients who underwent major hepatectomy for HCC from 2020 to 2023. We defined two groups; upfront hepatectomy and neoadjuvant therapy. Patient characteristics, preoperative and intraoperative factors, and postoperative outcomes were analyzed.

[RESULTS] Of 837 patients, 673 (80.4 %) had upfront hepatectomy, 164 (19.6 %) had neoadjuvant therapy. Neoadjuvant therapy patients were more likely to have preoperative albumin <3.5 gm/dL (23.1 vs 13.8 %, p = 0.004), pre-operative platelet count <150 10/jL (17.2 vs 10.6 %, p = 0.016), transfusions (36.6 vs 23.2 %, p < 0.001), biliary reconstruction (9.8 vs 5.5 %, p = 0.04) and operative time >300 min (51.2 vs 34.7 %, p < 0.001). Length of stay and 30-day mortality were similar. Multivariate analysis showed intraarterial therapy and hepatitis B were more predictive of developing grade B/C liver failure.

[CONCLUSIONS] While neoadjuvant therapy for HCC may increase surgical candidacy, patients may be sicker at resection and cases may be more challenging. Although early mortality is similar, neoadjuvant therapy may potentially affect liver function. More studies are needed to optimally select patients for conversion therapy.