Background : Textbook outcomes (TO) have been widely used as a single indicator to access surgical outcomes. There are several studies on the achievement of TO in liver surgery, but few studies have been conducted for hepatectomy only in patients with hepatocellular carcinoma (HCC). In this study, we analyze the achievement of TO in HCC patients undergoing hepatectomy and identify predictive factors that affect the achievement of TO. We also investigated whether TO affects long-term survival.

Methods : This retrospective study included patients who underwent liver surgery for HCC between 2008 and 2022. TO was defined as no major complications, no in-hospital mortality, no intraoperative transfusion, no readmission after discharge, no prolonged length of stay (LOS), and the presence of R0 resection margin. Multivariate logistic regression analysis was used to analyze factors that predicted TO achievement and whether TO achievement affected long-term survival.

Results : A total of 1763 patients were included in the study, of which 67.8% (n=1196) achieved TO. Multivariate analysis showed that liver cirrhosis (OR=0.681, p=0.001), tumor size (≥2.7cm) (OR=0.678, p=0.001), multiple tumors (OR=0.692, p=0.034), platelet count ≤ 100K (OR=0.423, p<0.001), and albumin-bilirubin (ALBI) grade 2/3 (OR=0.441, p<0.001) were independent predictors of achieving TO. The group that achieved TO showed better results in overall survival and recurrence-free survival compared to the group that did not achieve TO. (p<0.001)

Conclusions : Liver cirrhosis, tumor size ≥2.7cm, multiple tumors, platelet count ≤ 100K and ALBI grades 2/3 were independent predictors for achieving TO after hepatectomy in HCC patients, and those who achieved TO had better long-term survival.