T. Gocho1, K. Nakashima1, Y. Shirai1, R. Marukuchi1, J. Yasuda1, H. Shiozaki1, K. Furukawa1, S. Onda1, H. Shiba1, Y. Ishida1, K. Yanaga1 1Jikei University School of Medicine,Department Of Surgery,Tokyo, Japan
Introduction:
Anatomical resection (AR) for hepatocellular carcinoma (HCC) has been reported to have better outcome compared to non-anatomical resection (NR). However, the specific benefit of AR for HCC judged treatable with partial resection remains unclear. The aim of this study is to evaluate the clinical impact of anatomical resection for HCC treatable with partial resection.
Patients and
Methods:
Two-hundred and sixty three patients were treated with primary hepatectomy for HCC between May 1997 and December 2016 at Jikei University Hospital. Of those, 80 patients with solitary tumor which were judged treatable by partial hepatectomy based on preoperative imaging were retrospectively reviewed. We divided such patients into two groups according to the types of resection (anatomical resection (AR) group (n = 28) treated by subsegmentectomy and non-anatomical resection (NR) group (n = 52) treated by partial hepatectomy) and patient factors (age, sex, viral status, ICG R15, Child-Pugh (C-P) grade), tumor factors (size, preoperative AFP and PIVKA-II values and portal vein (PV) invasion), operative factors (operative time, blood loss and blood transfusion) and outcomes (overall (OS) and disease-free (DFS) survival and complications) were assessed.
Results:
The following variables were comparable: sex, HBV infection, HCV infection, ICG 15, C-P grade, Preop. AFP, tumor size, pathological PV invasion, blood loss, blood transfusion and complications. However, AR group had older patients (≥ 65 years) (60% vs. 28.8%, p <0.05), higher preop. PIVKA-II (≥ 100 mAU/ml) (71% vs. 46.2%, p < 0.05) and longer operative time (≥ 360 min) (61% vs. 45%, p < 0.05), which were not independent risk factors related to DFS and OS after primary hepatectomy. There were no statistical difference in 5-year DFS and 5-year OS between AR group and NR group (53% vs. 36%, p = 0.096 and 70% vs. 67%, p = 0.714, respectively). However, for HCC 2 cm or larger, statistically higher 5-year DFS was achieved in AR group as compared with NR group (53% vs. 31%, p = 0.041), while no significant difference was observed in 5-year OS (73% vs. 64%, p = 0.488). Twenty seven of 52 patients in NR group developed intrahepatic recurrence, whose recurrence was in the same subsegment in 9 (33%) and in the other segment in 18 (67%) patients. There was no statistical difference in 5-year OS after recurrence between those with recurrence in the same subsegment and the other subsegment (p = 0.764).
Conclusion:
Anatomical resection (subsegmentectomy) seems to improve DFS of patients with HCC 2 cm or larger in diameter.