Risk Factors of Complications from Central Bisectionectomy (H458) for Hepatocellular Carcinoma: A Multi-Institutional Single-Arm Analysis

SIMPLE SUMMARY: This study aims to clarify the specific perioperative risk factors and short-term patient prognosis after central bisectionectomy (CB) for hepatocellular carcinoma (HCC). The specific operative risk factors for liver failure and increased blood loss in 142 HCC patients undergoing CB (H458) were tumor involvement in segment 1, tumor size exceeding 10 cm, and compression of the main vasculature. The three-year survival after CB was favorable and curable under precise preoperative simulations, elaborate techniques, and management. Large tumor size, surrounding tumor involvement, or compression to major vasculatures, and the related iBL were independent risk factors for severe morbidities in CB. These results showed the limits of up-front CB, which is useful information for deciding other novel non-operative treatments for conversion surgery. ABSTRACT: Background: This study aims to clarify the perioperative risk factors and short-term prognosis of central bisectionectomy (CB) for hepatocellular carcinoma (HCC). Methods: Surgical data from 142 selected patients out of 171 HCC patients who underwent anatomical CB (H458) between 2005 and 2020 were collected from 17 expert institutions in a single-arm retrospective study. Results: Morbidities recorded by the International Study Group of Liver Surgery (ISGLS) from grade BC post-hepatectomy liver failure (PHLF) and bile leakage (PHBL), or complications requiring intervention were observed in 37% of patients. A multivariate analysis showed that increased blood loss (iBL) > 1500 mL from PHLF (risk ratio [RR]: 2.79), albumin level < 4 g/dL for PHBL (RR, 2.99), involvement of segment 1, a large size > 6 cm, or compression of the hepatic venous confluence or cava by HCC for all severe complications (RR: 5.67, 3.75, 6.51, and 8.95, respectively) (p < 0.05) were significant parameters. Four patients (3%) died from PHLF. HCC recurred in 50% of 138 surviving patients. The three-year recurrence-free and overall survival rates were 48% and 81%, respectively. Conclusions: Large tumor size and surrounding tumor involvement, or compression of major vasculatures and the related iBL > 1500 mL were independent risk factors for severe morbidities in patients with HCC undergoing CB.