Background Textbook Outcome in Liver Surgery (TOLS) is a comprehensive metric for surgical success, surpassing traditional measures of morbidity and mortality. However, the prognostic value of TOLS in hepatocellular carcinoma (HCC) remains underexplored due to the complexities of liver disease. This study analyzes the achievement rates, temporal changes, and predictive factors of TOLS in HCC patients who underwent liver resection at our center and evaluates its impact on oncologic outcomes. Methods A retrospective analysis was conducted on 1878 HCC patients undergoing liver resection at our center from 2008 to 2022. Cases were divided into three periods to evaluate temporal trends. TOLS and TOLS+, an extended definition incorporating prolonged length of stay, were analyzed alongside overall survival (OS) and recurrence-free survival (RFS). Predictive factors for TOLS were identified through multivariate analyses. Results TOLS was achieved in 89.1% of patients and TOLS+ was achieved in 66.8%. Factors positively influencing TOLS included ALBI grade I and laparoscopic surgery, whereas cirrhosis, larger tumor size, and multiple tumors negatively impacted TOLS. Over time, the rates of TOLS and TOLS + improved significantly (p < 0.05) with a reduction in major complications (p = 0.008). Patients achieving TOLS and TOLS + exhibited significantly improved oncological outcomes. Conclusions Achieving TOLS and TOLS + strongly correlates with improved survival outcomes in HCC patients, emphasizing their importance as markers of perioperative success. Liver function, tumor size, and surgical approach are critical factors influencing TOLS. Further research is needed to refine strategies for optimizing TOLS and its role in long-term cancer management.
Jeong et al. (Fri,) studied this question.