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Equivalent Outcomes After Anatomical and Non-anatomical Resection of Small Hepatocellular Carcinoma in Patients with Preserved Liver Function

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Abstract

Background

Although anatomical resection (AR) is considered better than non-anatomical resection (NAR) for the treatment for hepatocellular carcinoma (HCC), there is only limited evidence in support of this argument.

Aim

The aim of this study was to investigate whether AR is superior to NAR regarding postoperative outcomes in patients with small solitary HCC and preserved liver function.

Methods

The study subjects were 92 curatively-resected patients with adequate liver function reserve (indocyanine green retention rate at 15 min <15%, prothrombin time >70%, serum albumin >3.5 g/dl) and macroscopically small (≤3.0 cm) solitary HCC without macroscopic vascular invasion; 30 patients underwent AR and 62 patients NAR. Postoperative short-term outcomes including mortality and morbidity and long-term outcomes were compared in the two groups.

Results

There was no significant difference in clinicopathological background in the two groups. Although resected liver volume was significantly larger in the AR group than the NAR group (p < 0.0001), no significant differences were detected in the incidence of mortality or morbidity. For long-term outcomes, there were no significant differences between the two groups in disease-free survival or overall survival. Multivariate analysis showed that the extent of surgical procedure was not a significant prognostic factor for disease-free or overall survival.

Conclusions

AR of a solitary small HCC did not carry postoperative outcome advantages compared with NAR in patients with preserved liver function. We recommend NAR for hepatic resection of small solitary HCC in patients with preserved liver function.

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References

  1. Bosch FX, Ribes J, Diaz M, Cleries R. Primary liver cancer: worldwide incidence and trends. Gastroenterology. 2004;127:S5–S16.

    Article  PubMed  Google Scholar 

  2. Lai EC, Fan ST, Lo CM, Chu KM, Liu CL, Wong J. Hepatic resection for hepatocellular carcinoma. An audit of 343 patients. Ann Surg. 1995;221:291–298.

    Article  PubMed  CAS  Google Scholar 

  3. Torzilli G, Makuuchi M, Inoue K, et al. No-mortality liver resection for hepatocellular carcinoma in cirrhotic and noncirrhotic patients: Is there a way? A prospective analysis of our approach. Arch Surg. 1999;134:984–992.

    Article  PubMed  CAS  Google Scholar 

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

    PubMed  CAS  Google Scholar 

  5. Makuuchi M, Imamura H, Sugawara Y, Takayama T. Progress in surgical treatment of hepatocellular carcinoma. Oncology. 2002;62:74–81.

    Article  PubMed  Google Scholar 

  6. Hsia CY, Lui WY, Chau GY, King KL, Loong CC, Wu CW. Perioperative safety and prognosis in hepatocellular carcinoma patients with impaired liver function. J Am Coll Surg. 2000;190:574–579.

    Article  PubMed  CAS  Google Scholar 

  7. Kanematsu T, Takenaka K, Matsumata T, Furuta T, Sugimachi K, Inokuchi K. Limited hepatic resection effective for selected cirrhotic patients with primary liver cancer. Ann Surg. 1984;199:51–56.

    Article  PubMed  CAS  Google Scholar 

  8. Kaibori M, Matsui Y, Hijikawa T, Uchida Y, Kwon AH, Kamiyama Y. Comparison of limited and anatomic hepatic resection for hepatocellular carcinoma with hepatitis C. Surgery. 2006;139:385–394.

    Article  PubMed  Google Scholar 

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

    PubMed  Google Scholar 

  10. Hasegawa K, Kokudo N, Imamura H, et al. Prognostic impact of anatomic resection for hepatocellular carcinoma. Ann Surg. 2005;242:252–259.

    Article  PubMed  Google Scholar 

  11. Ueno S, Kubo F, Sakoda M, et al. Efficacy of anatomic resection vs nonanatomic resection for small nodular hepatocellular carcinoma based on gross classification. J Hepatobiliary Pancreat Surg. 2008;15:493–500.

    Article  PubMed  Google Scholar 

  12. Wakai T, Shirai Y, Sakata J, et al. Anatomic resection independently improves long-term survival in patients with T1–T2 hepatocellular carcinoma. Ann Surg Oncol. 2007;14:1356–1365.

    Article  PubMed  Google Scholar 

  13. Imamura H, Matsuyama Y, Miyagawa Y, et al. Prognostic significance of anatomical resection and des-gamma-carboxy prothrombin in patients with hepatocellular carcinoma. Br J Surg. 1999;86:1032–1038.

    Article  PubMed  CAS  Google Scholar 

  14. Kobayashi A, Miyagawa S, Miwa S, Nakata T. Prognostic impact of anatomical resection on early and late intrahepatic recurrence in patients with hepatocellular carcinoma. J Hepatobiliary Pancreat Surg. 2008;15:515–521.

    Article  PubMed  Google Scholar 

  15. Tanaka K, Shimada H, Matsumoto C, et al. Anatomic versus limited nonanatomic resection for solitary hepatocellular carcinoma. Surgery. 2008;143:607–615.

    Article  PubMed  Google Scholar 

  16. Eguchi S, Kanematsu T, Arii S, et al. 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. 2008;143:469–475.

    Article  PubMed  Google Scholar 

  17. Sakon M, Nagano H, Nakamori S, et al. Intrahepatic recurrences of hepatocellular carcinoma after hepatectomy: analysis based on tumor hemodynamics. Arch Surg. 2002;137:94–99.

    Article  PubMed  Google Scholar 

  18. Sakon M, Nagano H, Shimizu J, et al. Hepatic resection of hepatocellular carcinomas based on tumor hemodynamics. J Surg Oncol. 2000;73:179–181.

    Article  PubMed  CAS  Google Scholar 

  19. Liver Cancer Study Group of Japan. General rules for the Clinical and Pathological Study of Primary Liver Cancer (in Japanese), 5th ed. Tokyo: Kanehara; 2008.

  20. Pugh RN, Murray-Lyon IM, Dawson JL, Pietroni MC, Williams R. Transection of the oesophagus for bleeding oesophageal varices. Br J Surg. 1973;60:646–649.

    Article  PubMed  CAS  Google Scholar 

  21. Couinaud C. Lobes et segments hepatiques. Presse Med. 1954;62:709–712.

    PubMed  CAS  Google Scholar 

  22. Edmondson HA, Steiner PE. Primary carcinoma of the liver: a study of 100 cases among 48,900 necropsies. Cancer. 1954;7:462–503.

    Article  PubMed  CAS  Google Scholar 

  23. Regimbeau JM, Kianmanesh R, Farges O, Dondero F, Sauvanet A, Belghiti J. Extent of liver resection influences the outcome in patients with cirrhosis and small hepatocellular carcinoma. Surgery. 2002;131:311–317.

    Article  PubMed  Google Scholar 

  24. Sakon M, Umeshita K, Nagano H, et al. Clinical significance of hepatic resection in hepatocellular carcinoma: analysis by disease-free survival curves. Arch Surg. 2000;135:1456–1459.

    Article  PubMed  CAS  Google Scholar 

  25. Bernardi M, Grazi GL, Colantoni A, et al. Prognostic indicators in patients with cirrhosis and hepatocellular carcinoma undergoing surgical resection. J Surg Oncol. 1993;3:67–69.

    Article  CAS  Google Scholar 

  26. de Boer MT, Molenaar IQ, Porte RJ. Impact of blood loss on outcome after liver resection. Dig Surg. 2007;24:259–264.

    Article  PubMed  Google Scholar 

  27. Katz SC, Shia J, Liau KH, et al. Operative blood loss independently predicts recurrence and survival after resection of hepatocellular carcinoma. Ann Surg. 2009;249:617–623.

    Article  PubMed  Google Scholar 

  28. Ogasawara K, Une Y, Nakajima Y, Uchino J. The significance of measuring liver volume using computed tomographic images before and after hepatectomy. Surg Today. 1995;25:43–48.

    Article  PubMed  CAS  Google Scholar 

  29. Tani M, Tomiya T, Yamada S, et al. Regulating factors of liver regeneration after hepatectomy. Cancer Chemother Pharmacol. 1994;33:S29–S32.

    Article  PubMed  Google Scholar 

  30. Zoli M, Marchesini G, Melli A, et al. Evaluation of liver volume and liver function following hepatic resection in man. Liver. 1986;6:286–291.

    PubMed  CAS  Google Scholar 

  31. Polignano FM, Quyn AJ, de Figueiredo RS, Henderson NA, Kulli C, Tait IS. Laparoscopic versus open liver segmentectomy: prospective, case-matched, intention-to-treat analysis of clinical outcomes and cost effectiveness. Surg Endosc. 2008;22:2564–2570.

    Article  PubMed  Google Scholar 

  32. Poon RT. Current role of laparoscopic surgery for liver malignancies. Surg Technol Int. 2007;16:73–81.

    PubMed  Google Scholar 

  33. Vanounou T, Steel JL, Nguyen KT, et al. Comparing the clinical and economic impact of laparoscopic versus open liver resection. Ann Surg Oncol. 2010;17:998–1009.

    Article  PubMed  Google Scholar 

  34. Buell JF, Cherqui D, Geller DA, et al. The international position on laparoscopic liver surgery: the Louisville statement, 2008. Ann Surg. 2009;250:825–830.

    Article  PubMed  Google Scholar 

  35. Kobayashi S, Nagano H, Marubashi S, et al. A single-incision laparoscopic hepatectomy for hepatocellular carcinoma: initial experience in a Japanese patient. Minim Invasive Ther Allied Technol. 2010;19:367–371.

    Article  PubMed  Google Scholar 

  36. Figueredo EJ, Yeung RS. Laparoscopic liver resection. Medscape J Med. 2008;10:68.

    PubMed  Google Scholar 

  37. Belghiti J, Cortes A, Abdalla EK, et al. Resection prior to liver transplantation for hepatocellular carcinoma. Ann Surg 2003;238:885–892; discussion 892–883.

    Google Scholar 

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Correspondence to Hiroaki Nagano.

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Tomimaru, Y., Eguchi, H., Marubashi, S. et al. Equivalent Outcomes After Anatomical and Non-anatomical Resection of Small Hepatocellular Carcinoma in Patients with Preserved Liver Function. Dig Dis Sci 57, 1942–1948 (2012). https://doi.org/10.1007/s10620-012-2114-7

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  • DOI: https://doi.org/10.1007/s10620-012-2114-7

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