One-versus two-stage partial hepatectomy for large resectable solitary hepatocellular carcinomas determined preoperatively to have a narrow resection margin:a propensity score matching analysis

Background:For patients with a large but resectable solitary hepatocellular carcinoma(HCC)of>5 cm in diameter,it is often difficult to achieve a sufficient resection margin.There is still no study on whether a two-stage hepatectomy to increase a narrow resection margin would be beneficial.Methods:From August 2014 to February 2017,patients with a large but resectable solitary HCC of>5 cm and a preoperative estimated resection margin of<1.0 cm were retrospectively studied.They were divided into one-and two-stage resection groups.A retrospective analysis was performed,followed by propensity score matching(PSM)analysis.Disease recurrence,survival,intraoperative and postoperative data were compared.Results:Before PSM,the 1-,2-,3-and 4-year recurrence-free survival rates for the one-and two-stage groups were 44.3%,31.7%,24.3%,19.2%versus 60.6%,45.4%,43.5%,32.3%,respectively(P=0.007).The corresponding OS rates were 61.0%,45.2%,43.8%,38.4%versus 69.6%,62.5%,60.7%,57.3%,respectively(P=0.029).After PSM,the 1-,2-,3-and 4-year recurrence-free survival rates for the one-and two-stage groups were 44.0%,31.5%,27.3%,21.0%versus 60.6%,45.4%,43.5%,32.3%,respectively(P=0.013).The corresponding OS rates were 62.5%,41.1%,41.1%,37.5%versus 69.6%,62.5%,60.7%,57.3%,respectively(P=0.038).Differences in the resection margins between the one-and two-stage groups before[0.3(0-0.5)versus 1.2(0.8-2.2)cm]and after[0.2(0-0.5)versus 1.2(0.8-2.2)cm]PSM were also significant.Conclusions:Two-stage hepatectomy allowed a wider resection margin for patients with a resectable but solitary HCC of>5 cm,and resulted in significantly better long-term survival outcomes after partial hepatectomy.