Comparison of anatomic and non-anatomic resections for very early-stage hepatocellular carcinoma: The importance of surgical resection margin width in non-anatomic resection

Su, Che; Chou, Chung Ching; Yang, Tsung Han; Lin, Yih Jyh

doi:10.1016/j.suronc.2020.11.009

Cited by 18 publications

(17 citation statements)

References 28 publications

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“…PSM overcomes some of these biases. Some real-world studies have demonstrated the superior overall or disease-free survival benefit of AR over NAR [ 7 , 8 , 9 , 10 , 11 ], whereas other studies have found no such benefits [ 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 ].…”

Section: Discussionmentioning

confidence: 99%

“…Several studies and meta-analyses have demonstrated the superiority of AR over NAR in terms of long-term survival outcome and recurrence [ 7 , 8 , 9 , 10 , 11 ]. On the other hand, while a review of well-designed comparative studies suggested comparable outcomes between AR and NAR [ 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 ], these studies examined solitary and primary HCCs less than 5 cm in size. Thus, this study analysed the survival outcomes of AR and NAR of HCCs including multiple lesions and different tumour sizes.…”

Section: Introductionmentioning

confidence: 99%

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Effects of Anatomical or Non-Anatomical Resection of Hepatocellular Carcinoma on Survival Outcome

Kwon

Lee

et al. 2022

JCM

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Background: The relative benefit of anatomical resection (AR) versus non-anatomical resection (NAR) in hepatocellular carcinoma (HCC) remains controversial. This study compared the survival outcomes and recurrence rates of HCCs analysed according to tumour size and the extent of resection. Methods: Consecutive patients with HCC who underwent curative resection at Asan Medical Center between January 1999 and December 2009 were included in this study. We performed propensity score matching (PSM) according to tumour size to compare the survival outcomes between AR and NAR. A total of 986 patients were analysed; 812 and 174 patients underwent AR and NAR, respectively. Results: Before PSM, regardless of tumour size, the AR group demonstrated significantly better 5-year overall survival (OS) and recurrence-free survival (RFS) than the NAR group (p < 0.001). After PSM, the AR group demonstrated better OS and RFS rates than the NAR group when tumour size was less than 5 cm, but there was no significant difference in the OS and RFS rates between the two groups when tumour size was equal to or greater than 5 cm. In tumours less than 5 cm in size, AR was the most significant factor associated with OS and RFS. However, this prognostic effect of AR was not demonstrated in tumours with sizes equal to or greater than 5 cm. Conclusion: In patients with HCCs smaller than 5 cm, AR reduced the risk of tumour recurrence and improved OS. In HCCs larger than 5 cm, AR and NAR showed comparable survival outcomes.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Effects of Anatomical or Non-Anatomical Resection of Hepatocellular Carcinoma on Survival Outcome

Kwon

Lee

et al. 2022

JCM

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“…Most intrahepatic recurrences were considered to arise from intrahepatic metastasis by venous dissemination, which a wide resection margin could not prevent. However, recent studies [37][38][39][40][41] suggest that HCC patients with narrow resection margin were associated with a higher tumor recurrence rate and a shorter DFS. A multicenter retrospective study [42] concluded that AR with a negative 0-mm surgical margin may be acceptable in patients with a single hepatocellular carcinoma.…”

Section: Discussionmentioning

confidence: 99%

Oncological outcomes of anatomic versus non-anatomic resections for small hepatocellular carcinoma: systematic review and meta-analysis of propensity-score matched studies

et al. 2022

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Background Primary liver cancer is the second-most commonly occurring cancer and has resulted in numerous deaths worldwide. Hepatic resection is of two main types, i.e., anatomic resection (AR) and non-anatomic resection (NAR). The oncological outcomes of hepatocellular carcinoma (HCC) patients after AR and NAR are still considered controversial. Therefore, we aimed to compare the impact of AR and NAR on the oncological outcomes of HCC patients with tumor diameters ≤ 5 cm using the propensity score matching method and research-based evidence. Method A systematic literature search was conducted. The main outcomes were disease-free survival (DFS), overall survival (OS), intrahepatic recurrence rate, and extrahepatic metastasis rate. Relative risk (RR) was calculated from forest plots and outcomes using random-effects model (REM). Result AR significantly improved DFS at 1, 3. and 5 years after surgery, compared to NAR (RR = 1.09, 95% CI = 1.04–1.15, P = 0.0003; RR = 1.16, 95% CI = 1.07–1.27, P = 0.0005; RR = 1.29, 95% CI = 1.07–1.55, P = 0.008). However, both of the difference in DFS at 7 years and OS at 1 and 3 years after AR versus that after NAR were not statistically significant. Nevertheless, the long-term OS associated with AR (5, 7, and 10 years) was superior to that associated with NAR (RR = 1.12, 95% CI = 1.03–1.21, P = 0.01; RR = 1.19, 95% CI = 1.04–1.36, P = 0.01; RR = 1.18, 95% CI = 1.05–1.34, P = 0.008). The difference in the intrahepatic recurrence rate after AR versus that after NAR was not statistically significant, but the extrahepatic metastasis rate after AR was significantly lower than that observed after NAR (RR = 0.61, 95% CI = 0.40–0.94, P = 0.03). Conclusion Therefore, AR should be the preferred surgical approach for HCC patients with tumor diameters ≤ 5 cm. Trial registration PROSPERO registration number CRD42022330596.

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“…In the present case, we actively carried out a PVE to chase a preferred surgical outcome. PVE is not only for huge tumor that leads to insufficient FLR, but can also be applied to small centrally seated tumor, for which enough surgical margin needs to be guaranteed [ 13 , 14 ].…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic right hemihepatectomy following a novel optimized portal vein embolization: a video case report

Liu

Ding

et al. 2022

BMC Gastroenterol

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Background This article is the first report of laparoscopic major hepatectomy of Hepatocellular carcinoma (HCC) following optimized portal vein embolization (oPVE). Case presentation The patient was diagnosed with a single 3 × 3.5 cm HCC located in segment 5 and 8 detected by enhanced computed tomography and magnetic resonance imaging. The lesion was adjacent to the right anterior and posterior portal veins, making it difficult to confirm the adequate liver functional remnant volume, surgical margin and R0 resection. In addition, the liver cirrhosis induced by a long history of chronic hepatitis B virus increased the potential risk of postoperative liver failure and refractory ascites. Therefore, we conducted a laparoscopic surgery following oPVE, by which the safe tumor margin was ensured and the outcome of the surgery was improved. The patient was discharged on the seventh day after the surgery. The AFP gradually decreased to a normal level during the 90-day follow-up. Conclusion This case report demonstrates that, in experienced hands for selected patients, laparoscopic hepatectomy after portal vein embolization is feasible and may be an alternative to open liver resection.

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Comparison of anatomic and non-anatomic resections for very early-stage hepatocellular carcinoma: The importance of surgical resection margin width in non-anatomic resection

Cited by 18 publications

References 28 publications

Effects of Anatomical or Non-Anatomical Resection of Hepatocellular Carcinoma on Survival Outcome

Effects of Anatomical or Non-Anatomical Resection of Hepatocellular Carcinoma on Survival Outcome

Oncological outcomes of anatomic versus non-anatomic resections for small hepatocellular carcinoma: systematic review and meta-analysis of propensity-score matched studies

Laparoscopic right hemihepatectomy following a novel optimized portal vein embolization: a video case report

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