Single Stage Versus Two Stage Hepatectomy: A Comparative Analysis of Outcomes, Safety, and Clinical Applications

Abstract

Objective: The current study aims to compare the results, safety, and clinical use of single-stage and two-stage hepatectomy, their effectiveness, complications, and long-term survival of patients who need liver tumor resections.

Study Design: Retrospective study
Place and Duration of Study: This study was conducted at the Hepato-Pancreato-Biliary & Liver Transplant Surgery Department, Pir Abdul Qadir Shah Jeelani Institute of Medical Sciences, Gambat from August 2025 to
October 2025.

Methods: One hundred and fifty patients with liver tumors subjected to either single-stage or two-stage 
hepatectomy at our institution were then examined retrospectively. The patients were grouped according to tumor burden, sufficiency of FLR, and general health status. Demographic information, surgical results, complications, and survival rates were obtained. Statistical analysis was done with SPSS, which involved t-tests of continuous variables and chi-square of categorical variables. The average age of the patients and p-values were obtained to determine the significance of group differences. The institutional review board gave its ethical approval, and informed consent was obtained from all the participants. 

Results: Of the 100 patients 50 underwent single-stage hepatectomy, and 50 underwent two-stage hepatectomy. The mean age of the patients was 58 years (SD = 6.4). The overall survival rate was 75% for the single-stage group and 72% for the two-stage group. Complications were more common in the two-stage group, with 12% experiencing bile leaks compared to 4% in the single-stage group. The average hospital stay was significantly longer for the two-stage group (16 days, SD = 5.1) compared to the single-stage group (10 days, SD = 3.2). R0 resection rates were 88% in the two-stage group versus 80% in the single-stage group, though the difference was not statistically significant (p = 0.08). Postoperative liver failure occurred in 5% of patients in the two-stage group and 12% in the single-stage group, with no significant difference (p = 0.12). 

Conclusion:  Single-stage as well as two-stage hepatectomy are both feasible surgical methods used in the resection of liver tumors. Although single-stage hepatectomy is related to fewer complications and reduced hospitalization, two-stage hepatectomy is more appropriate in patients with bilobar tumors or insufficient FLR. Survival rates are also similar in the long term, and proper patient selection on the basis of tumor burden and liver performance is a key to success.