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

Abstract

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.

Resection Margin Width Does Not Influence the Prognosis of Solitary Hepatocellular Carcinoma After Anatomic Resection: A Real-World Study from China

“…Despite being a subject of controversy, the prevailing view maintains that AR surpasses NAR in terms of reducing postoperative recurrence. 6 , 20 Moreover, the necessity of achieving extensive RM in patients undergoing AR remains underreported. In this study, a total of 1033 patients who were diagnosed with solitary HCC and underwent AR at two specialized HPB centers were analyzed.…”

Anatomic versus non-anatomic resection for early-stage intrahepatic cholangiocarcinoma: a propensity score matching and stabilized inverse probability of treatment weighting analysis

“…As early as 1985, Makuuchi et al [ 27 ] introduced the concept of AR and it has become widely used in clinical practice in recent years. Compared with NAR, AR is more extensive and allows the removal of the tumor as well as any potential intrahepatic metastases, thereby reducing postoperative recurrence rates and improving long-term survival [ 35 , 36 ]. In addition, AR has the potential to reduce intraoperative bleeding and postoperative complications despite its controversy [ 8 , 36 ].…”

Recurrence Pattern Is an Independent Surgical Prognostic Factor for Long-Term Oncological Outcomes in Patients with Hepatocellular Carcinoma

“…Anatomical hepatectomies were more prevalent in eastern countries; nevertheless, their adoption remains controversial due to surgeon-related confounding factors and challenges associated with establishing a precise definition. Moreover, patients’ outcomes could be better in cases with smaller tumors [ 13 , 14 ]. Although minimal invasive surgery offers superior short-term outcomes when compared with open surgery, its oncologic outcomes need to be carefully examined [ 15 ].…”