Anatomic versus limited nonanatomic resection for solitary hepatocellular carcinoma

Background Although anatomic liver resection is preferred when treating hepatocellular carcinoma (HCC), evidence that it improves survival when compared with an adequate nonanatomic resection is lacking. The purpose of this study was to compare the survival impact of anatomic versus nonanatomic rese...

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Bibliographic Details
Published in:Surgery 2008-05, Vol.143 (5), p.607-615
Main Authors: Tanaka, Kuniya, MD, PhD, Shimada, Hiroshi, MD, PhD, Matsumoto, Chizuru, MD, Matsuo, Kenichi, MD, Nagano, Yasuhiko, MD, Endo, Itaru, MD, PhD, Togo, Shinji, MD, PhD
Format: Article
Language:English
Subjects:
Adult
Aged
Aged, 80 and over
Biological and medical sciences
Carcinoma, Hepatocellular - mortality
Carcinoma, Hepatocellular - pathology
Carcinoma, Hepatocellular - surgery
Disease-Free Survival
Female
Gastroenterology. Liver. Pancreas. Abdomen
General aspects
Hepatectomy - methods
Humans
Japan - epidemiology
Liver Function Tests
Liver Neoplasms - mortality
Liver Neoplasms - pathology
Liver Neoplasms - surgery
Liver. Biliary tract. Portal circulation. Exocrine pancreas
Male
Medical sciences
Middle Aged
Neoplasm Recurrence, Local - epidemiology
Retrospective Studies
Surgery
Tumors
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Summary:Background Although anatomic liver resection is preferred when treating hepatocellular carcinoma (HCC), evidence that it improves survival when compared with an adequate nonanatomic resection is lacking. The purpose of this study was to compare the survival impact of anatomic versus nonanatomic resection in patients with solitary HCC. Patients and Methods Clinicopathologic data were available for 125 patients who underwent hepatectomy for a solitary HCC confined to 1 or 2 Couinaud's segments. These patients were divided into 2 groups based on the hepatectomy procedure: anatomic (n = 83) and nonanatomic (n = 42) resection. Results No differences were detected either in the hepatic recurrence rates ( P = .38) or in the overall survival rates ( P = .34) between the anatomic group and the nonanatomic group. The hepatectomy procedure (anatomic vs nonanatomic resection) did not affect survival in either univariate ( P = 0.34) or multivariate analysis (relative risk, 1.574; P = .22). The proportion of patients who survived after recurrence was greater in the nonanatomic (15/42) than the anatomic group (13/83; P = .049), and the median survival time after recurrence was greater in patients who underwent nonanatomic resection (991 days; range, 131-4073 days) than in patients with anatomic resection (310 days; range, 48-1887 days; P = .045). Conclusions No superiority was seen in survival when HCC was treated by anatomic resection. Maintaining adequate liver function regardless of whether the resection is anatomic or not may be of greater importance.
ISSN:0039-6060
1532-7361
DOI:10.1016/j.surg.2008.01.006