Safety of Elective Hepatectomy Performed on Weekends for Patients with Hepatocellular Carcinoma

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Safety of Elective Hepatectomy Performed on Weekends for Patients with Hepatocellular Carcinoma

Hepatocellular carcinoma (HCC)—the most common type of liver cancer— is rising globally, with China accounting for over half of new cases worldwide, according to the International Agency for Research on Cancer (IARC). As patient numbers grow, hospitals face pressure to reduce wait times for life-saving surgery. One solution? Performing elective hepatectomy (planned liver cancer surgery) on weekends. But is this safe? A 2022 study from West China Hospital, Sichuan University, suggests yes—for carefully selected patients.

The research, led by Junlong Dai, Junyi Shen, Xiaoyun Zhang, Wei Peng, Tianfu Wen, and Chuan Li from the Department of Liver Surgery and Liver Transplantation Center, analyzed data from 1646 patients who underwent elective hepatectomy for HCC between 2014 and 2019. At West China Hospital, elective surgeries are routinely offered on Saturdays, with doctors choosing weekend cases based on clinical need and personal schedule.

To ensure fair comparisons (and reduce bias from factors like tumor size or liver function), the team used propensity score matching (PSM)—a statistical tool that balances groups by age, gender, liver health, tumor characteristics, and other key variables. After matching, 207 patients remained in both the weekday and weekend groups.

What the Study Found

The team evaluated two types of outcomes: short-term (immediate recovery) and long-term (survival over time).

Short-Term Safety

After PSM, weekend and weekday patients had similar results:

  • Length of stay (LOS): Both groups stayed in the hospital for about 10 days on average.
  • 90-day mortality: Less than 6% of patients in either group died within 90 days of surgery—a low rate for major cancer surgery.
  • Complications: Severe complications (rated Clavein-Dindo class ≥3, like major infections or organ failure) were rare and similar between groups (4.8% for weekends vs. 6.8% for weekdays). The Comprehensive Complication Index (CCI), which measures overall complication severity, also showed no difference.
  • Patient comfort: Weekday patients had slightly more nausea/vomiting and pulmonary infections, but these were minor.

Long-Term Survival

The team tracked two key metrics:

  • Overall survival (OS): How long patients lived after surgery.
  • Recurrence-free survival (RFS): How long until cancer returned.

Before matching, weekday patients had better OS—likely because weekend patients initially had worse liver function, more cirrhosis, and lower rates of antiviral medication use. After PSM? No significant difference:

  • 5-year OS: 52.7% for weekdays vs. 57% for weekends.
  • 5-year RFS: 59.2% for weekdays vs. 54% for weekends.

A Cox regression model (used to identify risk factors for poor outcomes) confirmed that weekend surgery itself did not affect survival or recurrence.

Why This Matters (and How It Differs from Previous Research)

Previous studies on the “weekend effect”—higher mortality or complications for weekend surgeries—focused on emergency cases, not planned elective surgery. This study is one of the first to examine routine weekend hepatectomy, and it shows that when patients are carefully selected (e.g., meeting Milan criteria for liver transplant eligibility, simpler tumors), the risks are identical to weekday surgery.

West China Hospital also took steps to ensure safety:

  • Same staffing as weekdays: Labs, imaging, and medical interventions are available routinely on weekends.
  • Thorough pre-op evaluations: Weekend patients undergo detailed checks to confirm they’re good candidates for surgery.

These measures likely helped eliminate the “weekend effect” for elective cases.

The Takeaway

For HCC patients, this study is good news: elective weekend hepatectomy is a safe option that can reduce wait times. For hospitals, it’s a way to manage growing caseloads without compromising care. And for doctors, it offers more flexibility in scheduling—all while keeping patients safe.

As the global burden of HCC grows, findings like these are critical to expanding access to life-saving surgery. The key? Careful patient selection and consistent hospital protocols—proving that weekend surgery can work when done right.

Dai J, Shen J, Zhang X, Peng W, Wen T, Li C. Safety of elective hepatectomy performed on weekend for patients with hepatocellular carcinoma. Chin Med J 2022;135:2596–2598. doi.org/10.1097/CM9.0000000000001722

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