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.
Similar content being viewed by others
References
Bosch FX, Ribes J, Diaz M, Cleries R. Primary liver cancer: worldwide incidence and trends. Gastroenterology. 2004;127:S5–S16.
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.
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.
Makuuchi M, Hasegawa H, Yamazaki S. Ultrasonically guided subsegmentectomy. Surg Gynecol Obstet. 1985;161:346–350.
Makuuchi M, Imamura H, Sugawara Y, Takayama T. Progress in surgical treatment of hepatocellular carcinoma. Oncology. 2002;62:74–81.
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.
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.
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.
Cho YB, Lee KU, Lee HW, et al. Anatomic versus non-anatomic resection for small single hepatocellular carcinomas. Hepatogastroenterology. 2007;54:1766–1769.
Hasegawa K, Kokudo N, Imamura H, et al. Prognostic impact of anatomic resection for hepatocellular carcinoma. Ann Surg. 2005;242:252–259.
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.
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.
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.
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.
Tanaka K, Shimada H, Matsumoto C, et al. Anatomic versus limited nonanatomic resection for solitary hepatocellular carcinoma. Surgery. 2008;143:607–615.
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.
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.
Sakon M, Nagano H, Shimizu J, et al. Hepatic resection of hepatocellular carcinomas based on tumor hemodynamics. J Surg Oncol. 2000;73:179–181.
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.
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.
Couinaud C. Lobes et segments hepatiques. Presse Med. 1954;62:709–712.
Edmondson HA, Steiner PE. Primary carcinoma of the liver: a study of 100 cases among 48,900 necropsies. Cancer. 1954;7:462–503.
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.
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.
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.
de Boer MT, Molenaar IQ, Porte RJ. Impact of blood loss on outcome after liver resection. Dig Surg. 2007;24:259–264.
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.
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.
Tani M, Tomiya T, Yamada S, et al. Regulating factors of liver regeneration after hepatectomy. Cancer Chemother Pharmacol. 1994;33:S29–S32.
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.
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.
Poon RT. Current role of laparoscopic surgery for liver malignancies. Surg Technol Int. 2007;16:73–81.
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.
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.
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.
Figueredo EJ, Yeung RS. Laparoscopic liver resection. Medscape J Med. 2008;10:68.
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.
Conflict of interest
None.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
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
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10620-012-2114-7