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Meta-analysis of anatomic resection versus nonanatomic resection for hepatocellular carcinoma

  • Systematic Review and Meta-Analysis
  • Published:
Langenbeck's Archives of Surgery Aims and scope Submit manuscript

Abstract

Purpose

The choice between anatomic resection (AR) versus nonanatomic resection (NAR) for hepatocellular carcinoma (HCC) is controversial. This study is a meta-analysis of the available evidence.

Methods

A systematic review and meta-analysis of trials comparing AR with NAR for HCC published from 1985 to 2009 in PubMed and Medline database, Cochrane database, Embase database, and Science Citation index were conducted. Overall survival, disease-free survival, and local recurrence rate were considered as primary outcomes. Pooled effect was calculated using either the fixed effects model or random effects model.

Results

Sixteen nonrandomized studies involving 2,917 patients were analyzed; 1,577 patients were in the AR group, and 1,340 were in the NAR group. Patients in the AR group were characterized by lower prevalence of cirrhosis and hepatitis virus infection, more favorable hepatic function, and larger tumor size compared with patients in the NAR group. AR provided a better 5-year overall survival than NAR (OR, 1.63; 95% CI, 1.15–2.32). Local recurrence (OR, 0.28; 95% CI, 0.16–0.50) and early (≤2 years) recurrence (OR, 0.55; 95 CI, 0.34–0.89) were all significantly lower in the AR group. AR improved disease-free survival significantly at 3 years (OR, 2.09; 95% CI, 1.52–2.88) and 5 years (OR, 2.24; 95% CI, 1.85–2.72). No differences were found between the two groups with respect to postoperative morbidity, mortality, and length of hospital stay.

Conclusions

AR was superior to NAR in terms of better survival and preventing local recurrence for the treatment of HCC.

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References

  1. Llovet JM, Burroughs A, Bruix J (2003) Hepatocellular carcinoma. Lancet 362:1907–1917. doi:10.1016/S0140-6736(03)14964-1

    Article  PubMed  Google Scholar 

  2. Zhou Y, Sui C, Li B, Yin Z, Tan Y, Yang J, Liu Z (2010) Repeat hepatectomy for recurrent hepatocellular carcinoma: a local experience and a systematic review. World J Surg Oncol 8:55. doi:10.1186/1477-7819-8-55

    Article  PubMed  Google Scholar 

  3. Adachi E, Maeda T, Kajiyama K, Kinukawa N, Matsumata T, Sugimachi K, Tsuneyoshi M (1996) Factors correlated with portal venous invasion by hepatocellular carcinoma: univariate and multivariate analyses of 232 resected cases without preoperative treatments. Cancer 77:2022–2031

    Article  PubMed  CAS  Google Scholar 

  4. Park JH, Koh KC, Choi MS et al (2006) Analysis of risk factors associated with early multinodular recurrences after hepatic resection for hepatocellular carcinoma. Am J Surg 192:29–33. doi:10.1016/j.amjsurg.2005.11.010

    Article  PubMed  Google Scholar 

  5. Vauthey JN, Lauwers GY, Esnaola NF et al (2002) Simplified staging for hepatocellular carcinoma. J Clin Oncol 20:1527–1536. doi:10.1200/JCO.20.6.1527

    Article  PubMed  Google Scholar 

  6. Makuuchi M, Hasegawa H, Yamazaki S (1985) Ultrasonically guided subsegmentectomy. Surg Gynecol Obstet 161:346–350

    PubMed  CAS  Google Scholar 

  7. Fuster J, García-Valdecasas JC, Grande L et al (1996) Hepatocellular carcinoma and cirrhosis. Results of surgical treatment in a European series. Ann Surg 223:297–302

    Article  PubMed  CAS  Google Scholar 

  8. Imamura H, Matsuyama Y, Miyagawa Y, Ishida K, Shimada R, Miyagawa S, Makuuchi M, Kawasaki S (1999) Prognostic significance of anatomical resection and des-gamma-carboxy prothrombin in patients with hepatocellular carcinoma. Br J Surg 86:1032–1038

    Article  PubMed  CAS  Google Scholar 

  9. Yamamoto M, Takasaki K, Ohtsubo T, Katsuragawa H, Fukuda C, Katagiri S (2001) Effectiveness of systematized hepatectomy with Glisson's pedicle transection at the hepatic hilus for small nodular hepatocellular carcinoma: retrospective analysis. Surgery 130:443–448. doi:10.1067/msy.2001.116406

    Article  PubMed  CAS  Google Scholar 

  10. Suh KS (2005) Systematic hepatectomy for small hepatocellular carcinoma in Korea. J Hepatobiliary Pancreat Surg 12:365–370. doi:10.1007/s00534-005-1002-3

    Article  PubMed  Google Scholar 

  11. Yamashita Y, Taketomi A, Itoh S, Kitagawa D, Kayashima H, Harimoto N, Tsujita E, Kuroda Y, Maehara Y (2007) Long term favorable results of limited hepatic resections for patients with hepatocellular carcinoma: 20 years of experience. J Am Coll Surg 205:19–26. doi:10.1016/j.jamcollsurg.2007.01.069

    Article  PubMed  Google Scholar 

  12. Kaibori M, Matsui Y, Hijikawa T, Uchida Y, Kwon AH, Kamiyama Y (2006) Comparison of limited and anatomic hepatic resection for hepatocellular carcinoma with hepatitis C. Surgery 139:385–394. doi:10.1016/j.surg.2005.08.035

    Article  PubMed  Google Scholar 

  13. Hasegawa K, Kokudo N, Imamura H et al (2005) Prognostic impact of anatomic resection for hepatocellular carcinoma. Ann Surg 242:252–259. doi:10.1097/01.sla.0000171307.37401.db

    Article  PubMed  Google Scholar 

  14. Tanaka S, Mogushi K, Yasen M et al (2009) Surgical contribution to recurrence-free survival in patients with macrovascular-invasion-negative hepatocellular carcinoma. J Am Coll Surg 208:368–374. doi:10.1016/j.jamcollsurg.2008.10.031

    Article  PubMed  Google Scholar 

  15. Tanaka K, Shimada H, Matsumoto C et al (2008) Anatomic versus limited nonanatomic resection for solitary hepatocellular carcinoma. Surgery 143:607–615. doi:10.1016/j.surg.2008.01.006

    Article  PubMed  Google Scholar 

  16. Imamura H, Matsuyama Y, Tanaka E et al (2003) Risk factors contributing to early and late phase intrahepatic recurrence of hepatocellular carcinoma after hepatectomy. J Hepatol 38:200–207

    Article  PubMed  Google Scholar 

  17. Athanasiou T, Al-Ruzzeh S, Kumar P et al (2004) Off-pump myocardial revascularization is associated with less incidence of stroke in elderly patients. Ann Thorac Surg 77:745–53. doi:10.1016/j.athoracsur.2003.07.002

    Article  PubMed  Google Scholar 

  18. Simillis C, Constantinides VA, Tekkis PP et al (2007) Laparoscopic versus open hepatic resections for benign and malignant neoplasms–a meta-analysis. Surgery 141:203–211. doi:10.1016/j.surg.2006.06.035

    Article  PubMed  Google Scholar 

  19. Eguchi S, Kanematsu T, Arii S et al (2008) Comparison of the outcomes between an anatomical subsegmentectomy and a non-anatomical minor hepatectomy for single hepatocellular carcinomas based on a Japanese nationwide survey. Surgery 143(4):469–75. doi:10.1016/j.surg.2007.12.003

    Article  PubMed  Google Scholar 

  20. Cho YB, Lee KU, Lee HW et al (2007) Anatomic versus non-anatomic resection for small single hepatocellular carcinomas. Hepatogastroenterology 54:1766–1769

    PubMed  Google Scholar 

  21. Arii S, Tanaka S, Mitsunori Y, Nakamura N, Kudo A, Noguchi N, Irie T (2010) Surgical strategies for hepatocellular carcinoma with special reference to anatomical hepatic resection and intraoperative contrast-enhanced ultrasonography. Oncology 78(Suppl 1):125–130. doi:10.1159/000315240

    Article  PubMed  Google Scholar 

  22. Regimbeau JM, Kianmanesh R, Farges O, Dondero F, Sauvanet A, Belghiti J (2002) Extent of liver resection influences the outcome in patients with cirrhosis and small hepatocellular carcinoma. Surgery 131:311–317. doi:10.1067/msy.2002.121892

    Article  PubMed  Google Scholar 

  23. Wakai T, Shirai Y, Sakata J et al (2007) Anatomic resection independently improves long-term survival in patients with T1-T2 hepatocellular carcinoma. Ann Surg Oncol 14:1356–1365. doi:10.1245/s10434-006-9318-z

    Article  PubMed  Google Scholar 

  24. Nanashima A, Sumida Y, Abo T et al (2008) Comparison of survival between anatomic and non-anatomic liver resection in patients with hepatocellular carcinoma: significance of surgical margin in non-anatomic resection. Acta Chir Belg 108:532–537

    PubMed  CAS  Google Scholar 

  25. Kobayashi A, Miyagawa S, Miwa S, Nakata T (2008) Prognostic impact of anatomical resection on early and late intrahepatic recurrence in patients with hepatocellular carcinoma. J Hepatobiliary Pancreat Surg 15:515–521. doi:10.1007/s00534-007-1293-7

    Article  PubMed  Google Scholar 

  26. Ueno S, Kubo F, Sakoda M et al (2008) Efficacy of anatomic resection vs nonanatomic resection for small nodular hepatocellular carcinoma based on gross classification. J Hepatobiliary Pancreat Surg 15:493–500. doi:10.1007/s00534-007-1312-8

    Article  PubMed  Google Scholar 

  27. Kamiyama T, Nakanishi K, Yokoo H, Kamachi H, Matsushita M, Todo S (2010) The impact of anatomical resection for hepatocellular carcinoma that meets the Milan criteria. J Surg Oncol 101:54–60. doi:10.1002/jso.21414

    Article  PubMed  Google Scholar 

  28. Kang CM, Choi GH, Kim DH et al (2010) Revisiting the role of nonanatomic resection of small (< or = 4 cm) and single hepatocellular carcinoma in patients with well-preserved liver function. J Surg Res 160:81–89. doi:10.1016/j.jss.2009.01.021

    Article  PubMed  Google Scholar 

  29. Eltawil KM, Kidd M, Giovinazzo F, Helmy AH, Salem RR (2010) Differentiating the impact of anatomic and non-anatomic liver resection on early recurrence in patients with hepatocellular carcinoma. World J Surg Oncol 8:43. doi:10.1186/1477-7819-8-43

    Article  PubMed  Google Scholar 

  30. Yamazaki O, Matsuyama M, Horii K et al (2010) Comparison of the outcomes between anatomical resection and limited resection for single hepatocellular carcinomas no larger than 5 cm in diameter: a single-center study. J Hepatobiliary Pancreat Sci 17:349–358. doi:10.1007/s00534-009-0253-9

    Article  PubMed  Google Scholar 

  31. Takano S, Oishi H, Kono S, Kawakami S, Nakamura M, Kubota N, Iwai S (2000) Retrospective analysis of type of hepatic resection for hepatocellular carcinoma. Br J Surg 87:65–70. doi:10.1046/j.1365-2168.2000.01308.x

    Article  PubMed  CAS  Google Scholar 

  32. Mathurin P, Raynard B, Dharancy S et al (2003) Meta-analysis: evaluation of adjuvant therapy after curative liver resection for hepatocellular carcinoma. Aliment Pharmacol Ther 17:1247–1261. doi:10.1046/j.1365-2036.2003.01580.x

    Article  PubMed  CAS  Google Scholar 

  33. Poon RT (2009) Differentiating early and late recurrences after resection of HCC in cirrhotic patients: implications on surveillance, prevention, and treatment strategies. Ann Surg Oncol 16:792–794. doi:10.1245/s10434-009-0330-yOpenAccess

    Article  PubMed  Google Scholar 

  34. Song F, Eastwood AJ, Gilbody S, Duley L, Sutton AJ (2000) Publication and related biases. Health Technol Assess 4:1–105

    Google Scholar 

  35. Portolani N, Coniglio A, Ghidoni S et al (2006) Early and late recurrence after liver resection for hepatocellular carcinoma: prognostic and therapeutic implications. Ann Surg 243:229–235. doi:10.1097/01.sla.0000197706.21803.a1

    Article  PubMed  Google Scholar 

  36. Deeks JJ, Dinnes J, D'Amico R et al (2003) Evaluating non-randomised intervention studies. Health Technol Assess 7(iii-x):1–173

    Google Scholar 

  37. Ferguson D, Laupacis A, Salmi LR, McAlister FA, Huet C (2000) What should be included in meta-analysis? An exploration of methodological issues. Int J Technol Assess Health Care 16:1109–1119

    Article  Google Scholar 

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Acknowledgments

The authors thank Dr. Nanashima A and Shinichi Ueno, MD & PhD, for having kindly provided more details about their reported cases.

Conflicts of interest

None.

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Authors and Affiliations

  1. Department of Hepato-Biliary-Pancreato-Vascular Surgery, the First Affiliated Hospital of Xiamen University, 55 Zhenhai Road, Xiamen, 361003, Fujian Province, China

    Yanming Zhou, Donghui Xu, Lupeng Wu & Bin Li

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  1. Yanming Zhou
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  2. Donghui Xu
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  3. Lupeng Wu
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  4. Bin Li
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Corresponding author

Correspondence to Bin Li.

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Zhou, Y., Xu, D., Wu, L. et al. Meta-analysis of anatomic resection versus nonanatomic resection for hepatocellular carcinoma. Langenbecks Arch Surg 396, 1109–1117 (2011). https://doi.org/10.1007/s00423-011-0784-9

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  • DOI: https://doi.org/10.1007/s00423-011-0784-9

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