Survival Benefit and Safety of Anatomic Resection in Cirrhotic Hepatocellular Carcinoma: Propensity-Matched Analysis of 1699 Patients.

[BACKGROUND] The efficacy of anatomic resection (AR) versus non-anatomic resection (NAR) for hepatocellular carcinoma (HCC) remains controversial, particularly among patients with differing underlying liver conditions. This study aimed to compare the outcomes of AR and NAR in HCC patients with and without liver cirrhosis.

[METHODS] We retrospectively analyzed data from HCC patients who underwent hepatectomy at West China Hospital between 2010 and 2022. Patients were stratified based on the presence of liver cirrhosis. Propensity score matching (PSM) was then applied separately within each stratum (cirrhotic and non-cirrhotic) to compare perioperative outcomes and long-term prognosis between AR and NAR.

[RESULTS] A total of 1699 patients were enrolled, including 866 with cirrhosis and 833 without cirrhosis. Before PSM, AR was associated with significantly superior overall survival (OS) and recurrence-free survival (RFS) compared to NAR. Following PSM (1:1 matching based on resection type within each cirrhosis stratum), similar survival advantages for AR were observed. In the matched cirrhotic cohort (255 patients per group), the AR group exhibited significantly better OS (median: 36.5 vs. 25.2 months; p < 0.001) and RFS (median: 26.9 vs. 17.4 months; p < 0.001) compared to the NAR group. Similarly, in the matched non-cirrhotic cohort (284 patients per group), the AR group showed significantly improved OS (median: 36.3 vs. 23.9 months; p < 0.001) and RFS (median: 27.8 vs. 18.5 months; p < 0.001) compared to the NAR group. No significant differences were observed in perioperative outcomes, including postoperative complications and hospital length of stay.

[CONCLUSIONS] Compared to NAR, AR improved long-term prognosis in HCC patients. This survival benefit was evident even in cirrhotic patients and was not associated with increased perioperative risks.