Anatomical Versus Non-anatomical Resection for Hepatocellular Carcinoma, a Propensity-matched Analysis Between Taiwanese and Japanese Patients

Abstract

Background/Aim: The aim of the study was to compare the outcomes of anatomical resection (AR) versus non-anatomical resection (NAR) for Japanese and Taiwanese patients with single, resectable hepatocellular carcinoma (HCC). Patients and Methods: A propensity score matched (PSM) analysis was performed to compare the outcomes of the AR group to those of the NAR group. Tumor size <5 cm, T1 or T2 grade, without evidence of extrahepatic metastasis, invasion of portal or hepatic veins, or direct invasion of adjacent organs, were included in the study. Results: A total of 385 cases (Taiwanese 105, Japanese 280) were analyzed. After PSM, a total of 152 cases remain (Taiwan and Japan both 76 cases). Disease-free survival (DFS) and overall survival (OS) data were not significantly different between the two groups at 5 years follow-up. Conclusion: AR of HCC in Japanese patients has a similar 5-year DFS and OS as NAR of HCC in Taiwanese patients.Hepatocellular carcinoma (HCC) is one of the leading causes of cancer-related death worldwide. Although more prevalent in Asia, incidence has been increasing in the western countries (1, 2). First-line treatment for HCC includes both liver resection and radio frequency ablation, although the former may have prognostic advantages over the latter, as shown in several recent studies, especially in those with solitary and small tumors (3). In recent years, prognosis of HCC has improved due to better surgical techniques, pre-and peri-operative management, and aggressive multimodal treatment strategies after tumor recurrence (4, 5). However, recurrence remains high after curative hepatectomy, and is believed to be the main cause of early death. Tumor recurrence usually occurs by dissemination of tumor cells in the portal vein or metachronous multi-centric hepatocarcinogenesis, and are considered the most important factors associated with poor prognosis (6-8). Regarding resection techniques, anatomic resection (AR) was first proposed in the 1980s, first with dye-staining technique (9), and later with the Glissonean pedical transection method (10).

Is minimally invasive liver surgery a reasonable option in recurrent HCC? A snapshot from the I Go MILS registry

“…In the present series, the non-anatomical resection rates were 47.4% and 61.2% in Groups 1 and 2, respectively. The role of anatomical resection for HCC is still debating, and lots of studies have compared the two types of resections [14][15][16][17]. According to a comparative Asian study including 385 cases (Taiwanese 105, Japanese 280), after PSM, the disease-free survival (DFS) and overall survival (OS) data were not significantly different between the two groups at 5-year follow-up [14].…”

“…The role of anatomical resection for HCC is still debating, and lots of studies have compared the two types of resections [14][15][16][17]. According to a comparative Asian study including 385 cases (Taiwanese 105, Japanese 280), after PSM, the disease-free survival (DFS) and overall survival (OS) data were not significantly different between the two groups at 5-year follow-up [14]. The surgical eradication of HCC with anatomical resection is based on adequate clearance of the tumor together with the surrounding microenvironment niche.…”

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

“…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 ].…”

“…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.…”

Anatomical vs nonanatomical liver resection for solitary hepatocellular carcinoma: A systematic review and meta-analysis

“…In theory, AR can produce a better survival outcome by systematic removal of the tumor-bearing portal territories. However, as reported recently, some studies have found that non-anatomical resection (NAR) could achieve a more satisfactory outcome compared with AR[ 8 - 10 ]. Others have concluded that AR can significantly improve the long-term survival results[ 11 , 12 ].…”