Abstract:Background and Aims In cirrhotic patients undergoing radical hepatectomy for hepatocellular carcinoma (HCC), the technique used for hepatic transection may influence perioperative outcomes and long-term prognosis. This study compared argon plasma coagulation (APC) with a conventional electrosurgical knife (EK) in terms of postoperative complications and survival outcomes.Methods A retrospective analysis was conducted on 204 cirrhotic HCC patients who underwent radical hepatectomy in the 900th Hospital of PLA Joint Logistic Support Force between January 2013 and January 2020. Patients were divided into an APC group (n=103) and an EK group (n=101) according to the method used for hepatic transection. Perioperative outcomes, postoperative complications, overall survival (OS), and recurrence-free survival (RFS) were compared between groups.Results Baseline characteristics were comparable between the two groups (all P>0.05). The incidence of post-hepatectomy liver failure was significantly lower in the APC group than that in the EK group (0.0% vs. 5.9%, P=0.036), as was the intraoperative transfusion rate (12.6% vs. 23.8%, P=0.039). No significant differences were observed in postoperative day 1 liver function parameters, overall complications, or severe complications (all P>0.05). Survival analysis demonstrated significantly higher 1-, 3-, and 5-year OS and RFS rates in the APC group compared with the EK group (OS: P=0.034; RFS: P=0.003). Recurrence pattern analysis showed that no margin recurrence was observed in the APC group, whereas eight cases occurred in the EK group (P=0.011).Conclusion In cirrhotic patients undergoing radical hepatectomy for HCC, APC is associated with reduced PHLF and intraoperative transfusion without increasing perioperative morbidity, and is correlated with improved OS and RFS. These findings suggest that APC may provide oncological and safety advantages, warranting further validation in prospective multicenter studies.