Should the one-stage hepatectomy be performed for hepatitis B virus-related hepatocellular carcinoma patients with liver fibrosis or cirrhosis when the RLV/SLV is between 30% to 40%?

Abstract Background Currently, it is known whether associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) or one-stage hepatectomy (OSH) be applied as a treatment for hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC) patients with liver fibrosis or cirrhosis when the remnant liver volume (RLV) to standard liver volume (SLV) ratio is between 30–40% and the liver function is normal. Methods In this study, consecutive HBV-related HCC patients with liver fibrosis or cirrhosis who underwent right hepatectomy, with RLV/SLV between 30–40% and normal liver function (Child-pugh A and ICG-R15 < 10%) were enrolled from November 2014 to November 2022. The clinical datas of patients were recorded. Primary endpoints was post-hepatectomy liver failure (PHLF), while secondary endpoints were severe complication and mortality. The postoperative datas of patients were compared between OSH group and ALPPS group. Results Forty-two patients who underwent OSH were enrolled in our study. No significant difference was obtained in the incidence of PHLF between the OSH group (59.5%) and the ALPPS group (52.3%) (P = 0.411). The mortality within 90 days of the OSH group (0%) post-surgery was significantly lower compared with that of the ALPPS group (13.2%) (P = 0.006). Moreover, there was no significant difference in the incidence of severe complication (Clavien-Dindo classification ≥Ⅲa) between the OSH group (26.2%) and the ALPPS group (36.8%) (P = 0.199). Conclusion OSH may be an effective treatment option for patients with liver fibrosis or cirrhosis when the RLV/SLV is between 30–40% with normal liver function (Child-pugh A and ICG-R15 < 10%).