Prognostic impact of anatomic resection for hepatocellular carcinoma

Abstract

Objectives: To evaluate the prognostic impact of anatomic versus nonanatomic resection on the patients' survival after resection of a single hepatocellular carcinoma (HCC).

Summary of background data: Anatomic resection is a reasonable treatment option for HCC; however, its clinical significance remains to be confirmed.

Methods: Curative hepatic resection was performed for a single HCC in 210 patients; the patients were classified into the anatomic resection (n = 156) and nonanatomic resection (n = 54) groups. In 84 patients assigned to the anatomic resection group, segmentectomy or subsegmentectomy was performed. We evaluated the outcome of anatomic resection, including segmentectomy and subsegmentectomy, in comparison with that of nonanatomic resection, by the multivariate analysis taking into consideration 14 other clinical factors.

Results: Both the 5-year overall survival and disease-free survival rates in the anatomic resection group were significantly better than those in the nonanatomic resection group (66% versus 35%, P = 0.01, and 34% versus 16%, P = 0.006, respectively). In the segmentectomy and subsegmentectomy group, the 5-year overall and disease-free survival rates were 67% and 28%, respectively, both of which were also higher than the corresponding rates in the nonanatomic resection group (P = 0.007 and P = 0.001, respectively). The results of multivariate analysis revealed that anatomic resection was a significantly favorable factor for overall and disease-free survivals: the hazard ratios were 0.57 (95% confidence interval, 0.32-0.99, P= 0.04), and 0.65 (0.43-0.96, P = 0.03).

Conclusion: Anatomic resection for a single HCC yields more favorable results rather than nonanatomic resection.

Figures

FIGURE 1. The views before (A) and after (B) anatomic resection of segment 8. A, The surface of segment 8 is marked, according to the stained area after blue dye injection (arrowheads). B, The landmark veins were exposed longitudinally in the cutting surface: the inferior vena cava (*), the right hepatic vein (RHV), and the middle hepatic vein (MHV, arrowheads). The stumps of the ventral (arrow) and dorsal (arrowhead) branches of Glisson's triad in segment 8 are seen.

FIGURE 2. Overall (A) and disease-free (B) survival curves after anatomic and nonanatomic resections for a single hepatocellular carcinoma.

FIGURE 3. Overall (A) and disease-free (B) survival curves after segmentectomy and subsegmentectomy, and after nonanatomic resection, for a single hepatocellular carcinoma.