Skip to main content
SpringerLink
Log in

Comparison of Survival Outcomes Between Right Posterior Sectionectomy and Right Hepatectomy for Hepatocellular Carcinoma in Cirrhotic Liver: A Single-Centre Experience

  • Original Scientific Report
  • Published:
World Journal of Surgery Aims and scope Submit manuscript

Abstract

Background

Right hepatectomy (RH) instead of right posterior sectionectomy (RPS) is commonly performed for hepatocellular carcinoma (HCC) in cirrhotic livers located lateral to the right hepatic vein in order to ensure adequate resection margin. This potentially increased the risk of postoperative liver failure. This study aims to compare survival outcomes and surgical morbidities between RH and RPS.

Methods

All patients between 2003 and 2013 with resection for solitary HCC in cirrhotic livers at segment 6/7 were reviewed. Baseline demographics, liver function, perioperative outcomes, and overall (OS) and disease-free survival (DFS) were compared between RH and RPS.

Results

Eighty-one patients were included in this study. Thirty-two patients had RH and forty-nine with RPS were selected as controls. Majority of the HCC patients (91.4 %) suffered from chronic hepatitis B. There was no significant difference in age, gender and Child-Pugh grade between the two groups. The median tumour size of RH group was 6 vs. 4 cm in the RPS group (p < 0.0001). Both groups had no statistical difference in resection margin and their associated morbidities. The 5-year OS for RH and RPS was 76 and 83.8 %, respectively (p = 0.766), whereas their corresponding DFS was 52.6 and 52.2 % (p = 0.859). Despite the discrepancy of tumour size among the two groups, there was no statistical difference in subgroup analysis based on their corresponding stage of disease.

Conclusion

RPS can achieve similar OS and DFS as RH for HCC, and should be considered as the treatment of choice in order to optimise the postoperative remnant parenchymal liver functions.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Wong TC, Poon RT (2013) Hepatobiliary malignancies: lessons from Asia. Dig Dis 31(1):130–137

    Article  PubMed  Google Scholar 

  2. Poon RT (2007) Optimal initial treatment for early hepatocellular carcinoma in patients with preserved liver function: transplantation or resection? Ann Surg Oncol 14(2):541–547

    Article  PubMed  Google Scholar 

  3. Ishii M, Mizuguchi T, Kawamoto M et al (2014) Propensity score analysis demonstrated the prognostic advantage of anatomical liver resection in hepatocellular carcinoma. World J Gastroenterol 20(12):3335–3342

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  4. Sasaki K, Matsuda M, Ohkura Y et al (2013) Anatomical versus nonanatomical resection in patients with hepatocellular carcinoma located in the left lateral segment. Am Surg 79(11):1163–1170

    PubMed  Google Scholar 

  5. Pugh RN, Murray-Lyon IM, Dawson JL et al (1973) Transection of the oesophagus for bleeding oesophageal varices. Br J Surg 60(8):646–649

    Article  CAS  PubMed  Google Scholar 

  6. Lau H, Man K, Fan ST et al (1997) Evaluation of preoperative hepatic function in patients with hepatocellular carcinoma undergoing hepatectomy. Br J Surg 84(9):1255–1259

    Article  CAS  PubMed  Google Scholar 

  7. Fan ST, Ng IO, Poon RT et al (1999) Hepatectomy for hepatocellular carcinoma: the surgeon’s role in long-term survival. Arch Surg 134(10):1124–1130

    Article  CAS  PubMed  Google Scholar 

  8. Cheung TT, Ho CL, Lo CM et al (2013) 11C-acetate and 18F-FDG PET/CT for clinical staging and selection of patients with hepatocellular carcinoma for liver transplantation on the basis of Milan criteria: surgeon’s perspective. J Nucl Med 54(2):192–200

    Article  CAS  PubMed  Google Scholar 

  9. Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240(2):205–213

    Article  PubMed Central  PubMed  Google Scholar 

  10. Jia CK, Weng J, Chen YK et al (2014) Anatomic resection of liver segments 6-8 for hepatocellular carcinoma. World J Gastroenterol 20(15):4433–4439

    Article  PubMed Central  PubMed  Google Scholar 

  11. Chun YS, Ribero D, Abdalla EK et al (2008) Comparison of two methods of future liver remnant volume measurement. J Gastrointest Surg 12(1):123–128

    Article  PubMed  Google Scholar 

  12. Llovet JM, Fuster J, Bruix J (1999) Intention-to-treat analysis of surgical treatment for early hepatocellular carcinoma: resection versus transplantation. Hepatology 30(6):1434–1440

    Article  CAS  PubMed  Google Scholar 

  13. Poon RT, Fan ST, Lo CM et al (2000) Long-term prognosis after resection of hepatocellular carcinoma associated with hepatitis B-related cirrhosis. J Clin Oncol 18(5):1094–1101

    CAS  PubMed  Google Scholar 

  14. Cha CH, Ruo L, Fong Y et al (2003) Resection of hepatocellular carcinoma in patients otherwise eligible for transplantation. Ann Surg 238(3):315–321 discussion 321–313

    PubMed Central  PubMed  Google Scholar 

  15. Shi J, Sun Q, Wang Y et al (2014) Comparison of microwave ablation and surgical resection for treatment of hepatocellular carcinomas conforming to Milan Criteria. J Gastroenterol Hepatol 29(7):1500–1507

    Article  PubMed  Google Scholar 

  16. Yamamoto Y, Ikoma H, Morimura R et al (2014) Clinical analysis of anatomical resection for the treatment of hepatocellular carcinoma based on the stratification of liver function. World J Surg 38(5):1154–1163. doi:10.1007/s00268-013-2369-y

    Article  PubMed  Google Scholar 

  17. Wong TC, Cheung TT, Chok KS et al (2014) Treatment strategy to improve long-term survival for hepatocellular carcinoma smaller than 5 cm: major hepatectomy vs minor hepatectomy. World J Surg 38(9):2386–2394. doi:10.1007/s00268-014-2601-4

    Article  PubMed  Google Scholar 

  18. Bigourdan JM, Jaeck D, Meyer N et al (2003) Small hepatocellular carcinoma in Child A cirrhotic patients: hepatic resection versus transplantation. Liver Transpl 9(5):513–520

    Article  PubMed  Google Scholar 

  19. Yoo H, Kim JH, Ko GY et al (2011) Sequential transcatheter arterial chemoembolization and portal vein embolization versus portal vein embolization only before major hepatectomy for patients with hepatocellular carcinoma. Ann Surg Oncol 18(5):1251–1257

    Article  PubMed  Google Scholar 

  20. Mondry A, Loh M, Zhuo, S (2006) OSSE: an online sample size estimator. http://osse.bii.a-star.edu.sg/calculation1.php

Download references

Acknowledgments

Dr Yip would like to acknowledge the HCI international foundation, London for their charitable funding for this international hepato-pancreato-biliary fellowship at the University of Hong Kong.

Author information

Authors and Affiliations

  1. Department of Hepato-Pancreato-Biliary Surgery, Queen Mary Hospital, The University of Hong Kong, 102 Pok Fu Lam Road, Hong Kong, China

    Vincent S. K. Yip, Ronnie T. P. Poon, Kenneth S. H. Chok, Albert C. Y. Chan, Wing Chiu Dai, Simon H. Y. Tsang, See Ching Chan, Chung Mau Lo & Tan To Cheung

  2. Institute of Liver Studies, King’s College Hospital, Denmark Hill, SE5 9RS, London

    Vincent S. K. Yip

Authors
  1. Vincent S. K. Yip
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ronnie T. P. Poon
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Kenneth S. H. Chok
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Albert C. Y. Chan
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Wing Chiu Dai
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Simon H. Y. Tsang
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. See Ching Chan
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Chung Mau Lo
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Tan To Cheung
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Tan To Cheung.

Ethics declarations

Conflict of interest

None.

Funding

Self-funded.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Yip, V.S.K., Poon, R.T.P., Chok, K.S.H. et al. Comparison of Survival Outcomes Between Right Posterior Sectionectomy and Right Hepatectomy for Hepatocellular Carcinoma in Cirrhotic Liver: A Single-Centre Experience. World J Surg 39, 2764–2770 (2015). https://doi.org/10.1007/s00268-015-3146-x

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00268-015-3146-x

Keywords

Search

Navigation