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Effectiveness of Anatomical Resection for Small Hepatocellular Carcinoma: a Propensity Score–Matched Analysis of a Multi-institutional Database

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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

The superiority of outcomes associated with anatomical resection (AR) versus those associated with non-anatomical resection (NAR) remains controversial in patients with hepatocellular carcinoma (HCC). The aim of this study was to evaluate the significance of AR on therapeutic outcomes of patients with small HCCs (≤ 5 cm), using propensity score–matched (PSM) analysis.

Methods

A total of 195 patients who had undergone elective hepatic resection for small HCCs (≤ 5 cm) were included in this study. We conducted PSM analysis for baseline characteristics (age, sex, hepatitis virus status, retention rate of indocyanine green at 15 min, and Child-Pugh grade), preoperative serum α-fetoprotein, and tumor characteristics (tumor size, tumor number, portal vein invasion, and surgical margin status) to eliminate potential selection bias. The prognostic significance of AR on the disease-free and overall survival was analyzed in patients selected by PSM analysis.

Results

Applying PSM analysis, the patients were divided into PSM-AR (N = 66) and PSM-NAR (N = 66) groups. Disease-free survival was significantly better in the PSM-AR group than that of the PSM-NAR group (P = 0.018), while there was no significant difference in the overall survival between the PSM-AR and PSM-NAR groups (P = 0.292). The univariate HRs of the PSM-AR group were 0.55 (95% CI, 0.33–0.90) for disease-free survival and 0.61 (95% CI, 0.24–1.53) for overall survival, respectively. Remnant liver recurrence was significantly lower in the AR group (P = 0.014).

Conclusions

AR may improve the disease-free survival in HCC patients with tumors of ≤5 cm diameter.

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References

  1. Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018;68:394-424.

    Article  Google Scholar 

  2. Sakon M, Kobayashi S, Wada H, Eguchi H, Marubashi S, Takahashi H, Akita H, Gotoh K, Yamada D, Asukai K, Hasegawa S, Ohue M, Yano M, Nagano H. “Logic-Based Medicine” Is More Feasible than “Evidence-Based Medicine” in the Local Treatment for Hepatocellular Carcinoma. Oncology. 2020;98:259-266.

    Article  Google Scholar 

  3. Shim JH, Jun MJ, Han S, Lee YJ, Lee SG, Kim KM, Lim YS, Lee HC. Prognostic nomograms for prediction of recurrence and survival after curative liver resection for hepatocellular carcinoma. Ann Surg. 2015;261:939-946.

    Article  Google Scholar 

  4. Marubashi S, Gotoh K, Akita H, Takahashi H, Sugimura K, Miyoshi N, Motoori M, Kishi K, Noura S, Fujiwara Y, Ohue M, Nakazawa T, Nakanishi K, Ito Y, Yano M, Ishikawa O, Sakon M. Analysis of Recurrence Patterns After Anatomical or Non-anatomical Resection for Hepatocellular Carcinoma. Ann Surg Oncol. 2015;22:2243-2252.

    Article  Google Scholar 

  5. Shindoh J, Makuuchi M, Matsuyama Y, Mise Y, Arita J, Sakamoto Y, Hasegawa K, Kokudo N. Complete removal of the tumor-bearing portal territory decreases local tumor recurrence and improves disease-specific survival of patients with hepatocellular carcinoma. J Hepatol. 2016;64:594-600.

    Article  Google Scholar 

  6. Shindoh J, Kobayashi Y, Umino R, Kojima K, Okubo S, Hashimoto M. Successful Anatomic Resection of Tumor-Bearing Portal Territory Delays Long-Term Stage Progression of Hepatocellular Carcinoma. Ann Surg Oncol. 2021;28:844-853.

    Article  Google Scholar 

  7. Zhao H, Chen C, Gu S, Yan X, Jia W, Mao L, Qiu Y. Anatomical versus non-anatomical resection for solitary hepatocellular carcinoma without macroscopic vascular invasion: A propensity score matching analysis. J Gastroenterol Hepatol. 2017;32:870-878.

    Article  Google Scholar 

  8. Jiao S, Li G, Zhang D, Xu Y, Liu J, Li G. Anatomic versus non-anatomic resection for hepatocellular carcinoma, do we have an answer? A meta-analysis Int J Surg. 2020;80:243-255.

    Article  Google Scholar 

  9. Zhao H, Ding WZ, Wang H, Gu S, Yan XP, Sun SQ, Mao L, Jin HH, Qiu YD. Prognostic value of precise hepatic pedicle dissection in anatomical resection for patients with hepatocellular carcinoma. Medicine (Baltimore). 2020;99:e19475.

    Article  CAS  Google Scholar 

  10. Marubashi S, Gotoh K, Akita H, Takahashi H, Ito Y, Yano M, Ishikawa O, Sakon M. Anatomical versus non-anatomical resection for hepatocellular carcinoma. Br J Surg. 2015;102:776-784.

    Article  CAS  Google Scholar 

  11. Feng X, Su Y, Zheng S, Xia F, Ma K, Yan J, Li X, Tang W, Wang S, Bie P, Dong J. A double blinded prospective randomized trial comparing the effect of anatomic versus non-anatomic resection on hepatocellular carcinoma recurrence. HPB (Oxford). 2017;19:667-674.

    Article  Google Scholar 

  12. Hirokawa F, Kubo S, Nagano H, Nakai T, Kaibori M, Hayashi M, Takemura S, Wada H, Nakata Y, Matsui K, Ishizaki M, Uchiyama K. Do patients with small solitary hepatocellular carcinomas without macroscopically vascular invasion require anatomic resection? Propensity score analysis. Surgery. 2015;157:27-36.

    Article  Google Scholar 

  13. Yamamoto T, Yagi S, Uryuhara K, Kaihara S, Hosotani R. Clinical factors that affect the outcomes after anatomical versus non-anatomical resection for hepatocellular carcinoma. Surg Today. 2017;47:193-201.

    Article  Google Scholar 

  14. Kaibori M, Kon M, Kitawaki T, Kawaura T, Hasegawa K, Kokudo N, Ariizumi S, Beppu T, Ishizu H, Kubo S, Kamiyama T, Takamura H, Kobayashi T, Kim DS, Wang HJ, Kim JM, Han DH, Park SJ, Kang KJ, Hwang S, Roh Y, You YK, Joh JW, Yamamoto M. Comparison of anatomic and non-anatomic hepatic resection for hepatocellular carcinoma. J Hepatobiliary Pancreat Sci. 2017;24:616-626.

    Article  Google Scholar 

  15. Miyagawa S, Makuuchi M, Kawasaki S, Kakazu T. Criteria for safe hepatic resection. Am J Surg. 1995;169:589-594.

    Article  CAS  Google Scholar 

  16. Strasberg SM. Nomenclature of hepatic anatomy and resections: a review of the Brisbane 2000 system. J Hepatobiliary Pancreat Surg. 2005;12:351-355.

    Article  Google Scholar 

  17. Ueno S, Tanabe G, Nuruki K, Hamanoue M, Komorizono Y, Oketani M, Hokotate H, Inoue H, Baba Y, Imamura Y, Aikou T. Prognostic performance of the new classification of primary liver cancer of Japan (4th edition) for patients with hepatocellular carcinoma: a validation analysis. Hepatol Res. 2002;24:395-403.

    Article  Google Scholar 

  18. Eguchi S, Kanematsu T, Arii S, Okazaki M, Okita K, Omata M, Ikai I, Kudo M, Kojiro M, Makuuchi M, Monden M, Matsuyama Y, Nakanuma Y, Takayasu K. Comparison of the outcomes between an anatomical subsegmentectomy and a non-anatomical minor hepatectomy for single hepatocellular carcinomas based on a Japanese nationwide survey. Surgery. 2008;143:469-475.

    Article  Google Scholar 

  19. Hidaka M, Eguchi S, Okuda K, Beppu T, Shirabe K, Kondo K, Takami Y, Ohta M, Shiraishi M, Ueno S, Nanashima A, Noritomi T, Kitahara K, Fujioka H. Impact of Anatomical Resection for Hepatocellular Carcinoma With Microportal Invasion (vp1): A Multi-institutional Study by the Kyushu Study Group of Liver Surgery. Ann Surg. 2020;271:339-346.

    Article  Google Scholar 

  20. Zhong XP, Zhang YF, Mei J, Li SH, Kan A, Lu LH, Chen MS, Wei W, Guo RP. Anatomical versus Non-anatomical Resection for Hepatocellular Carcinoma with Microscope Vascular Invasion: A Propensity Score Matching Analysis. J Cancer. 2019;10:3950-3957.

    Article  Google Scholar 

  21. Shindoh J, Kawamura Y, Kobayashi Y, Akuta N, Kobayashi M, Suzuki Y, Ikeda K, Hashimoto M. Time-to-Interventional Failure as a New Surrogate Measure for Survival Outcomes after Resection of Hepatocellular Carcinoma. J Gastrointest Surg. 2020;24:50-57.

    Article  Google Scholar 

  22. Johnson PJ, Berhane S, Kagebayashi C, Satomura S, Teng M, Reeves HL, O’Beirne J, Fox R, Skowronska A, Palmer D, Yeo W, Mo F, Lai P, Iñarrairaegui M, Chan SL, Sangro B, Miksad R, Tada T, Kumada T, Toyoda H. Assessment of liver function in patients with hepatocellular carcinoma: a new evidence-based approach-the ALBI grade. J Clin Oncol. 2015;33:550-558.

    Article  Google Scholar 

  23. Haruki K, Shiba H, Saito N, Horiuchi T, Shirai Y, Fujiwara Y, Furukawa K, Sakamoto T, Yanaga K. Risk stratification using a novel liver functional reserve score of combination prothrombin time-international normalized ratio to albumin ratio and albumin in patients with hepatocellular carcinoma. Surgery. 2018;164:404-410.

    Article  Google Scholar 

  24. Imura S, Yamada S, Saito Y, Ikemoto T, Morine Y, Shimada M. Utility of cone unit liver resection for small hepatocellular carcinoma: a propensity score matched analysis. HPB (Oxford). 2020. https://doi.org/10.1016/j.hpb.2020.09.010.

  25. Berardi G, Igarashi K, Li CJ, Ozaki T, Mishima K, Nakajima K, Honda M, Wakabayashi G. Parenchymal Sparing Anatomical Liver Resections With Full Laparoscopic Approach: Description of Technique and Short-term Results. Ann Surg. 2019. https://doi.org/10.1097/SLA.0000000000003575.

  26. Kabashima A, Shimada S, Shimokawa M, Akiyama Y, Tanabe M, Tanaka S. Molecular and immunological paradigms of hepatocellular carcinoma: Special reference to therapeutic approaches. J Hepatobiliary Pancreat Sci. 2021;28:62-75.

    Article  Google Scholar 

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Acknowledgements

We would like to thank Editage (www.editage.com) for English language editing.

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Authors and Affiliations

  1. Department of Surgery, The Jikei University School of Medicine, 3-25-8, Nishi-Shinbashi, Minato-ku, Tokyo, 105-8461, Japan

    Koichiro Haruki, Kenei Furukawa, Yuki Fujiwara, Tomohiko Taniai, Ryoga Hamura, Yoshihiro Shirai, Jungo Yasuda, Hironori Shiozaki, Shinji Onda, Takeshi Gocho, Hiroaki Shiba, Teruyuki Usuba, Yukio Nakabayashi, Shuichi Fujioka, Tomoyoshi Okamoto & Toru Ikegami

  2. Department of Surgery, The Jikei University Katsushika Medical Center, Tokyo, Japan

    Teruyuki Usuba

  3. Department of Digestive Surgery, Kawaguchi Municipal Medical Center, Saitama, Japan

    Yukio Nakabayashi

  4. Department of Surgery, The Jikei University Kashiwa Hospital, Chiba, Japan

    Shuichi Fujioka

  5. Department of Surgery, The Jikei University Daisan Hospital, Tokyo, Japan

    Tomoyoshi Okamoto

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  1. Koichiro Haruki
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Correspondence to Koichiro Haruki.

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Haruki, K., Furukawa, K., Fujiwara, Y. et al. Effectiveness of Anatomical Resection for Small Hepatocellular Carcinoma: a Propensity Score–Matched Analysis of a Multi-institutional Database. J Gastrointest Surg 25, 2835–2841 (2021). https://doi.org/10.1007/s11605-021-04985-4

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