Association between achieving textbook outcomes and better survival after laparoscopic liver resection in the anterolateral segments in patients with hepatocellular carcinoma

Background The quality of surgical procedures are assessed by textbook outcomes (TO). Laparoscopic liver resection (LLR) is considered a standard treatment for hepatocellular carcinoma (HCC) in the anterolateral segments of the liver. The main objective of this study was to evaluate the factors affecting achievement of TO for LLR and its impact on survival. Methods We conducted a retrospective cohort study of patients who underwent LLR for lesions located in the anterolateral segments (n = 309). Patients were divided into TO and non-TO group. Results A TO was achieved in 55.0% of patients (n = 170). In multivariable analysis, Model for End-stage Liver Disease (MELD) score >= 10 (odds ratio[OR] 3.076; 95% confidence interval[CI] 1.134-8.342), absence of diabetes mellitus (OR: 2.325; 95% CI: 1.227-4.407) and thrombocytopenia (OR: 2.115; 95% CI: 1.134-8.342) were independently associated with not achieving TO. The 5-year overall (82.9% vs 72.8%, P = .017) and recurrence-free (48.8% vs 35.4%; P = .036) survival rates were significantly greater in the TO group than in the non-TO group. Conclusion The MELD score, thrombocytopenia, and hypoalbuminemia were independent risk factors influencing the achievement of TO. TO influences the short- and long-term outcomes after LLR for HCC.