Analysis of Recurrence Patterns After Anatomical or Non-anatomical Resection for Hepatocellular Carcinoma

Marubashi, Shigeru; Gotoh, Kunihito; Akita, Hirofumi; Takahashi, Hidenori; Sugimura, Keijiro; Miyoshi, Norikatsu; Motoori, Masaaki; Kutsukake, Kentaro; Noura, Shingo; Fujiwara, Yoshiyuki; Ohue, Masayuki; Nakazawa, Takahiro; Nakanishi, Katsuyuki; Ito, Yuri; Yano, Masahiko; Ishikawa, Osamu; Sakon, Masato

doi:10.1245/s10434-014-4214-4

Cited by 47 publications

(38 citation statements)

References 31 publications

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“…Several reports have demonstrated the effectiveness of anatomical resection for HCC in terms of postoperative recurrence and survival [23, 25–28]. In contrast, other reports have demonstrated no obvious superiority of anatomical resection compared with non-anatomical resection [24, 29, 30]. To date, the clinical benefit of anatomical resection even for early HCC remains controversial.…”

Section: Discussionmentioning

confidence: 99%

Optimal surgical strategy for hepatocellular carcinoma with portal vein tumor thrombus: A propensity score analysis

Zhang

Wei

et al. 2016

Oncotarget

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ObjectivesThe optimal surgical resection method for hepatocellular carcinoma (HCC) patients with portal vein tumor thrombus (PVTT) that maximizes both safety and long-term outcome has not yet been determined. The aim of this study was to compare the clinical outcomes following peeling off versus en bloc resection for PVTT.MethodsFrom 2005 to 2012, 252 patients with HCC and type I/II PVTT who underwent hepatic resection were divided into two groups according to whether they received en bloc resection (n = 113) or peeling off resection (n = 139). The clinical outcomes were compared before and after propensity score matching.ResultsThe propensity model matched 113 patients with en bloc resection for further analyses. After matching, overall survival (OS) and disease-free survival (DFS) rates were significantly increased in the en bloc group compared with the peeling off group (p = 0.011 and p = 0.015). A multivariate analysis indicated that en bloc resection independently improved both OS and DFS (HR = 1.471, 95% CI: 1.071-2.018, p = 0.017 and HR = 1.415, 95% CI: 1.068-1.874, P=0.016). The adverse events were not significantly different between the two groups. However, the peeling off group showed a significantly increased recurrence rate of vascular invasion compared with the en bloc group (23.9% vs. 9.7%, p = 0.005). Similar results were also demonstrated prior to the matched analysis.ConclusionsAn en bloc resection is safe and confers a survival advantage compared with a peeling off resection in HCC patients with PVTT; thus, en bloc resection should be recommended as a standard treatment for these patients when possible.

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Section: Discussionmentioning

confidence: 99%

Optimal surgical strategy for hepatocellular carcinoma with portal vein tumor thrombus: A propensity score analysis

Zhang

Wei

et al. 2016

Oncotarget

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“…It is a higher incidence area of micrometastasis around tumour and provides a more accurate resection range for radical surgery. Some surgeons believed that anatomic resection was not mandatory for prolonging survival . Over‐pursuing anatomic resection without considering the function of the residual liver might lead to liver failure post‐operatively.…”

Section: Discussionmentioning

confidence: 99%

Anatomic resection and wide resection margin play an important role in hepatectomy for hepatocellular carcinoma with peritumoural micrometastasis

Shi

Zhao

Liao

et al. 2019

ANZ Journal of Surgery

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Background Anatomic hepatectomy and wide resection margin may improve surgical outcome of patients with hepatocellular carcinoma (HCC), but not everyone gain survival benefit. It remains unclear what kind of patients would benefit from those surgical methods. We investigated the factors affecting survival of patients with HCC, with special attention paid to the surgical methods and pathological factors. Methods A retrospective analysis was conducted on 231 patients with hepatitis B‐related HCC who underwent surgery from August 2011 to November 2013 in authors' institute. The survival analysis included the following variables: gender, age, viral load, alpha‐fetoprotein, des‐γ‐carboxy prothrombin, tumour size, cirrhosis, blood transfusion, complications, resection method, resection margin, microvascular invasion (mVI), peritumoural satellite nodule, recurrence time and recurrent burden. Results The median follow‐up time was 59 months. A total of 196 patients (84.9%) recurred and 151 patients (65.4%) deceased due to the disease. Multivariate analysis showed that cirrhosis, mVI and periturmoral satellite nodules were independent risk factors affecting overall survival after operation. The comparison between anatomic resection and local resection, and wide resection margin and narrow resection margin showed no significant differences for recurrence‐free survival and overall survival, respectively (P = 0.089 and 0.068, 0.108 and 0.122). Stratified analysis revealed that anatomic resection and wide resection margin surgery improved survival when mVI or peritumoural satellite existed. Conclusion Anatomic resection and wide resection margin are effective methods to improve the surgical outcome of HCC with periturmoral micrometastasis, although tumour characteristics affect patients' survival more than surgical techniques.

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“…However, the available data remain insufficient to prove the prognostic advantage of AR because of substantial heterogeneity; the clinicopathologic features of patients who underwent AR or NAR are quite different among previous studies. To overcome the issue of selection bias, several case-controlled studies using PSM have recently been reported [30][31][32][33]. Cucchetti et al [30] reported favorable outcomes of AR in PS-matched populations in terms of recurrence-free survival and OS.…”

Section: Discussionmentioning

confidence: 99%

“…3 Overall survival in selected subgroup. AR anatomic resection, CI confidence interval, HBV hepatitis B virus, HCV hepatitis C virus, ICGR15 indocyanine green retention rate at 15 min, NAR non-anatomic resection, NBNC negative for hepatitis B surface antigen and hepatitis C antibody Okamura et al [32] and Marubashi et al [33] found no prognostic advantage of AR. Although these studies were performed in an attempt to minimize selection bias and imbalances in baseline characteristics by using PSM, major issues may lie in the lack of quality control of surgery and insufficient analysis of oncologic features.…”

Section: Discussionmentioning

confidence: 99%

Comparison of anatomic and non‐anatomic hepatic resection for hepatocellular carcinoma

Kaibori

Kon

Kitawaki

et al. 2017

J Hepato Biliary Pancreat

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Background The aim of the present study was to compare the prognostic impact of anatomic resection (AR) versus non-anatomic resection (NAR) on patient survival after resection of a single hepatocellular carcinoma (HCC). Methods To control for confounding variable distributions, a 1-to-1 propensity score match was applied to compare the outcomes of AR and NAR. Among 710 patients with a primary, solitary HCC of <5.0 cm in diameter that was resectable by either AR or NAR from 2003 to 2007 in Japan and Korea, 355 patients underwent NAR and 355 underwent AR of at least one section with complete removal of the portal territory containing the tumor. Results Overall survival (OS) was better in the AR than NAR group (hazard ratio 1.67, 95% confidence interval 1.28-2.19, P < 0.001) while disease-free survival showed no significant difference. Significantly fewer patients in the AR than NAR group developed intrahepatic HCC recurrence and multiple intrahepatic recurrences. Patients with poorly differentiated HCC who underwent AR had improved disease-free survival and OS. Conclusions Anatomic resection decreases the risk of tumor recurrence and improves OS in patients with a primary, solitary HCC of <5.0 cm in diameter.

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Analysis of Recurrence Patterns After Anatomical or Non-anatomical Resection for Hepatocellular Carcinoma

Abstract: The incidence and patterns of HCC recurrence were similar between the anatomical and nonanatomical resection. Recurrence by local dissemination may be considered to be negligible in both surgical methods.

Cited by 47 publications

References 31 publications

Optimal surgical strategy for hepatocellular carcinoma with portal vein tumor thrombus: A propensity score analysis

Optimal surgical strategy for hepatocellular carcinoma with portal vein tumor thrombus: A propensity score analysis

Anatomic resection and wide resection margin play an important role in hepatectomy for hepatocellular carcinoma with peritumoural micrometastasis

Comparison of anatomic and non‐anatomic hepatic resection for hepatocellular carcinoma

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