Objective To explore the impact of metabolic dysfunction-associated fatty liver disease (MAFLD) on the achievement of textbook outcome (TO) of patients with hepatocellular carcinoma (HCC) after hepatectomy, and to identify the risk factors affecting the achievement of TO of HCC patients after hepatectomy. Methods The data of patients with Barcelona Clinic Liver Cancer stage 0/A HCC who received primary hepatectomy at our center from 2014 to 2022 were retrospectively reviewed. Patients were divided into the MAFLD group and the non-MAFLD group based on whether coexisting MAFLD. Propensity score matching (PSM) was used to balance the baseline characteristics of the two groups. The achievement of TO and its seven items before and after PSM was compared between the two groups. Logistic regression was applied to analyze the independent risk factors affecting the achievement of TO based the total population. Results A total of 2 301 patients were included in this study. After PSM, 299 patients in each group were included in the analysis. After PSM, the TO achievement rate in the MAFLD group was 63.5% (190/299), which was significantly poor than that in the non-MAFLD group [71.6% (214/299)], χ2=4.395, P=0.036. Among the seven items of TO, the proportion of prolonged hospital stay in the MAFLD group was 29.4% (88/299), while that in the non-MAFLD group was 21.1% (63/299), the difference was statistically significant (χ2=5.537, P=0.019). The rates of ≥ Clavien-Dindo grade 3 complications within 30 days, perioperative blood transfusion, mortality within 90 days after surgery, readmission within 30 days after discharge, conversion from laparoscopic to open hepatectomy, and R0 resection rate were similar between the two groups (P>0.05). Multivariate logistic regression analysis confirmed that tumor diameter>5 cm [OR=1.539, 95%CI (1.264, 1.874), P<0.001], albumin-bilirubin grade 2 [OR=1.941, 95%CI (1.588, 2.372), P<0.001], FIB-4>3.25 [OR=1.545, 95%CI (1.273, 1.875), P<0.001], Barcelona Clinic Liver Cancer stage A [OR=1.696, 95%CI (1.132, 2.542), P=0.010], major hepatectomy [OR=1.431, 95%CI (1.178, 1.738), P<0.001], and MAFLD [OR=1.549, 95%CI (1.188, 2.019), P=0.001] were independent risk factors affecting the achievement of TO, but laparoscopic hepatectomy [OR=0.629, 95%CI (0.503, 0.786), P<0.001] was a protective factor for achieving TO. Conclusion HCC patients coexisting MAFLD have a higher incidence of prolonged hospital stay after hepatectomy and are less likely to achieve TO.
Citation：
BAI Liyuan, QIU Zhancheng, WU Youwei, ZHOU Ying, LI Chuan. Impact of metabolic dysfunction-associated fatty liver disease on the achievement of textbook outcome of patients with hepatocellular carcinoma after hepatectomy. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2026, 33(7): 902-908. doi: 10.7507/1007-9424.202604088
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