Wu’s classification-guided resection linked to better outcomes in frail patients with left-sided HCC

A single-center retrospective study at West China Hospital compared surgical strategies in 258 patients with left-sided hepatocellular carcinoma treated between 2009 and 2021. Frailty was defined by a hospital frailty risk score of at least 5. Wu’s classification guided selected anatomical segmental resections intended to preserve more liver tissue than traditional left lateral sectionectomy or left hemihepatectomy. Investigators assessed perioperative outcomes, overall survival and recurrence-free survival; propensity score matching yielded 93 patients per group.

In the matched comparison, classification-guided surgery was associated with lower intraoperative blood loss (P<0.001), fewer transfusions (P=0.018), fewer Clavien–Dindo grade ≥3 complications (P=0.014), shorter postoperative hospitalization (P<0.001) and lower hospitalization costs (P=0.035). Overall survival was higher (P=0.004), whereas recurrence-free survival did not differ significantly. Hospital frailty risk score was independently associated with overall survival (hazard ratio 1.672, 95% CI 1.498–1.866).

The findings support further evaluation of parenchyma-preserving anatomical resection in selected frail patients with left-sided HCC. However, the retrospective, single-center design leaves potential residual confounding despite matching. Absolute complication rates, survival estimates and the magnitude of differences in blood loss and hospital stay were not provided in the supplied text, limiting assessment of clinical benefit.