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Anatomic Resection for Hepatocellular Carcinoma: Prognostic Impact Assessed from Recurrence Treatment

  • Hepatobiliary Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

The oncologic advantage of anatomic resection (AR) for primary hepatocellular carcinoma (HCC) remains controversial. This study aimed to evaluate the clinical advantages of AR for primary HCC by using propensity score-matching and by assessing treatment strategies for recurrence after surgery.

Methods

The study reviewed data of patients who underwent AR or non-anatomic resection (NAR) for solitary HCC (≤ 5 cm) in two institutions between 2004 and 2017. Surgical outcomes were compared between the two groups in a propensity score-adjusted cohort. The time-to-interventional failure (TIF), defined as the elapsed time from resection to unresectable/unablatable recurrence, also was evaluated.

Results

The inclusion criteria were met by 250 patients: 77 patients (31%) with AR and 173 patients (69%) with NAR. In the propensity score-matched populations (AR, 67; NAR, 67), the 5-year recurrence-free survival (RFS) for AR was better than for NAR (62% vs 35%; P = 0.005). No differences, however, were found in the 5-year overall survival between the two groups (72% vs 78%; P = 0.666). The 5-year TIF rates for the NAR group (60%) also were similar to those for the AR group (66%) (P = 0.413). In the cohort of 67 patients, curative repeat resection or ablation therapy was performed more frequently for the NAR patients (42%) than for the AR patients (10%) (P < 0.001).

Conclusion

For solitary HCC, AR decreases recurrence after the initial hepatectomy. However, aggressive curative-intent interventions for recurrence compensate for the impaired RFS, even for patients undergoing NAR.

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Authors and Affiliations

  1. Department of Hepatobiliary-Pancreatic Surgery, Graduate School of Medicine, Juntendo University, Tokyo, Japan

    Masaaki Minagawa MD, Yoshihiro Mise MD, PhD, Hirofumi Ichida MD, PhD, Tomoya Mizuno MD, PhD, Ryuji Yoshioka MD, PhD, Hiroshi Imamura MD, PhD & Akio Saiura MD, PhD

  2. Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan

    Kiyohiko Omichi MD, PhD, Yosuke Inoue MD, PhD, Yu Takahashi MD, PhD & Akio Saiura MD, PhD

  3. Medical Technology Innovation Center, Juntendo University, Tokyo, Japan

    Naotake Yanagisawa PhD

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  1. Masaaki Minagawa MD
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  2. Yoshihiro Mise MD, PhD
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  3. Kiyohiko Omichi MD, PhD
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  4. Hirofumi Ichida MD, PhD
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Correspondence to Akio Saiura MD, PhD.

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Minagawa, M., Mise, Y., Omichi, K. et al. Anatomic Resection for Hepatocellular Carcinoma: Prognostic Impact Assessed from Recurrence Treatment. Ann Surg Oncol 29, 913–921 (2022). https://doi.org/10.1245/s10434-021-10380-9

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  • DOI: https://doi.org/10.1245/s10434-021-10380-9

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