Masaki Kaibori1, Masanori Kon1, Tomoki Kitawaki2, Takayuki Kawaura2, Kiyoshi Hasegawa3, Norihiro Kokudo3, Shunichi Ariizumi4, Toru Beppu5, Hiroyuki Ishizu6, Shoji Kubo7, Toshiya Kamiyama8, Hiroyuki Takamura9, Tsuyoshi Kobayashi10, Dong-Sik Kim11, Hee Jung Wang12, Jong Man Kim13, Dai Hoon Han14, Sang-Jae Park15, Koo Jeong Kang16, Shin Hwang17, Younghoon Roh18, Young Kyung You19, Jae-Won Joh13, Masakazu Yamamoto4. 1. Department of Surgery, Kansai Medical University, Osaka, Japan. 2. Department of Mathematics, Kansai Medical University, Osaka, Japan. 3. Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan. 4. Department of Surgery, Tokyo Women's Medical University, Tokyo, Japan. 5. Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, Kumamoto, Japan. 6. Department of Surgery, Sapporo Kosei Hospital, Sapporo, Japan. 7. Department of Hepato-Biliary-Pancreatic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan. 8. Department of Gastroenterological Surgery I, Hokkaido University Graduate School of Medicine, Sapporo, Japan. 9. Department of Gastroenterological Surgery, Kanazawa University, Ishikawa, Japan. 10. Department of Gastroenterological and Transplant Surgery, Applied Life Sciences, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan. 11. Department of Surgery, Korea University College of Medicine, Seoul, Korea. 12. Department of Surgery, Ajou University School of Medicine, Suwon, Korea. 13. Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. 14. Department of Surgery, Yonsei University College of Medicine, Seoul, Korea. 15. Center for Liver Cancer, National Cancer Center, Goyang, Korea. 16. Department of Surgery, Keimyung University Dongsan Medical Center, Daegu, Korea. 17. Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. 18. Department of Surgery, Dong-A University College of Medicine, Busan, Korea. 19. Department of Surgery, The Catholic University of Korea, Seoul, Korea.
Abstract
BACKGROUND: The aim of the present study was to compare the prognostic impact of anatomic resection (AR) versus non-anatomic resection (NAR) on patient survival after resection of a single hepatocellular carcinoma (HCC). METHODS: To control for confounding variable distributions, a 1-to-1 propensity score match was applied to compare the outcomes of AR and NAR. Among 710 patients with a primary, solitary HCC of <5.0 cm in diameter that was resectable by either AR or NAR from 2003 to 2007 in Japan and Korea, 355 patients underwent NAR and 355 underwent AR of at least one section with complete removal of the portal territory containing the tumor. RESULTS: Overall survival (OS) was better in the AR than NAR group (hazard ratio 1.67, 95% confidence interval 1.28-2.19, P < 0.001) while disease-free survival showed no significant difference. Significantly fewer patients in the AR than NAR group developed intrahepatic HCC recurrence and multiple intrahepatic recurrences. Patients with poorly differentiated HCC who underwent AR had improved disease-free survival and OS. CONCLUSIONS: Anatomic resection decreases the risk of tumor recurrence and improves OS in patients with a primary, solitary HCC of <5.0 cm in diameter.
BACKGROUND: The aim of the present study was to compare the prognostic impact of anatomic resection (AR) versus non-anatomic resection (NAR) on patient survival after resection of a single hepatocellular carcinoma (HCC). METHODS: To control for confounding variable distributions, a 1-to-1 propensity score match was applied to compare the outcomes of AR and NAR. Among 710 patients with a primary, solitary HCC of <5.0 cm in diameter that was resectable by either AR or NAR from 2003 to 2007 in Japan and Korea, 355 patients underwent NAR and 355 underwent AR of at least one section with complete removal of the portal territory containing the tumor. RESULTS: Overall survival (OS) was better in the AR than NAR group (hazard ratio 1.67, 95% confidence interval 1.28-2.19, P < 0.001) while disease-free survival showed no significant difference. Significantly fewer patients in the AR than NAR group developed intrahepatic HCC recurrence and multiple intrahepatic recurrences. Patients with poorly differentiated HCC who underwent AR had improved disease-free survival and OS. CONCLUSIONS: Anatomic resection decreases the risk of tumor recurrence and improves OS in patients with a primary, solitary HCC of <5.0 cm in diameter.
Authors: Jennifer A Kalil; Jennifer Poirier; Bjoern Becker; Robert Van Dam; Xavier Keutgen; Erik Schadde Journal: J Gastrointest Surg Date: 2019-02-12 Impact factor: 3.452