ArticleSurgical endoscopy2026
Comparing argon plasma coagulation and electrosurgical knife in sealing liver transection for hepatocellular carcinoma: prognosis and recurrence patterns.
Article in Surgical endoscopy, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundPostoperative recurrence remains a major challenge after curative hepatectomy for hepatocellular carcinoma (HCC). While surgical margin width and resection strategies have been extensively studied, the oncological impact of liver transection sealing techniques has received limited attention. This study compared argon plasma coagulation (APC) and electrosurgical knife (EK) in sealing the liver transection surface during curative resection for HCC.
methodsA total of 586 patients who underwent curative hepatectomy for HCC between 2013 and 2020 were retrospectively analyzed. Patients were classified into the APC and EK groups according to the liver transection sealing technique used. To balance baseline characteristics, 1:1 propensity score matching (PSM) was applied. Kaplan-Meier analysis was used to evaluate overall survival (OS), recurrence-free survival (RFS), and recurrence patterns, while Cox proportional hazards models with robust variance estimation were employed for statistical analysis. Sensitivity analyses were conducted to assess the robustness of the findings. Prespecified subgroup analyses were conducted to explore potential effect modifiers.
resultsAfter matching, 237 patient pairs with balanced covariates were analyzed. APC was associated with significantly improved RFS compared with EK (HR = 1.375, 95% CI 1.041-1.816, P = 0.023), while the OS difference did not reach statistical significance (HR = 1.639, 95% CI 0.965-2.782, P = 0.064). Multivariate analysis confirmed APC as an independent protective factor for RFS. APC markedly reduced surgical margin recurrence both before and after matching (P < 0.001). Subgroup analyses showed consistent RFS benefit across most strata, with suggesting greater OS benefit in patients with preserved hepatic function (ALBI grade 1).
conclusionAPC use during liver transection is associated with improved recurrence control after curative hepatectomy for HCC, primarily through reducing surgical margin recurrence. Selected patients with preserved hepatic reserve may derive additional survival benefit.
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