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Liu H, Hu FJ, Li H, Lan T, Wu H. Anatomical vs nonanatomical liver resection for solitary hepatocellular carcinoma: A systematic review and meta-analysis. World J Gastrointest Oncol 2021; 13:1833-1846. [PMID: 34853654 PMCID: PMC8603461 DOI: 10.4251/wjgo.v13.i11.1833] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 05/08/2021] [Accepted: 07/13/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The long-term survival of patients with solitary hepatocellular carcinoma (HCC) following anatomical resection (AR) vs non-anatomical resection (NAR) is still controversial. It is necessary to investigate which approach is better for patients with solitary HCC.
AIM To compare perioperative and long-term survival outcomes of AR and NAR for solitary HCC.
METHODS We performed a comprehensive literature search of PubMed, Medline (Ovid), Embase (Ovid), and Cochrane Library. Participants of any age and sex, who underwent liver resection, were considered following the following criteria: (1) Studies reporting AR vs NAR liver resection; (2) Studies focused on primary HCC with a solitary tumor; (3) Studies reporting the long-term survival outcomes (> 5 years); and (4) Studies including patients without history of preoperative treatment. The main results were overall survival (OS) and disease-free survival (DFS). Perioperative outcomes were also compared.
RESULTS A total of 14 studies, published between 2001 and 2020, were included in our meta-analysis, including 9444 patients who were mainly from China, Japan, and Korea. AR was performed on 4260 (44.8%) patients. The synthetic results showed that the 5-year OS [odds ratio (OR): 1.19; P < 0.001] and DFS (OR: 1.26; P < 0.001) were significantly better in the AR group than in the NAR group. AR was associated with longer operating time [mean difference (MD): 47.08; P < 0.001], more blood loss (MD: 169.29; P = 0.001), and wider surgical margin (MD = 1.35; P = 0.04) compared to NAR. There was no obvious difference in blood transfusion ratio (OR: 1.16; P = 0.65) or postoperative complications (OR: 1.24, P = 0.18).
CONCLUSION AR is superior to NAR in terms of long-term outcomes. Thus, AR can be recommended as a reasonable surgical option in patients with solitary HCC.
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Affiliation(s)
- Hu Liu
- Department of Liver Surgery, Liver Transplantation Division, Laboratory of Liver Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Feng-Juan Hu
- The Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Hui Li
- Department of Liver Surgery, Liver Transplantation Division, Laboratory of Liver Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Tian Lan
- Department of Liver Surgery, Liver Transplantation Division, Laboratory of Liver Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Hong Wu
- Department of Liver Surgery, Liver Transplantation Division, Laboratory of Liver Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
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Minagawa M, Mise Y, Omichi K, Ichida H, Mizuno T, Yoshioka R, Imamura H, Yanagisawa N, Inoue Y, Takahashi Y, Saiura A. Anatomic Resection for Hepatocellular Carcinoma: Prognostic Impact Assessed from Recurrence Treatment. Ann Surg Oncol 2021; 29:913-921. [PMID: 34549363 DOI: 10.1245/s10434-021-10380-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 06/15/2021] [Indexed: 11/18/2022]
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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Affiliation(s)
- Masaaki Minagawa
- Department of Hepatobiliary-Pancreatic Surgery, Graduate School of Medicine, Juntendo University, Tokyo, Japan
| | - Yoshihiro Mise
- Department of Hepatobiliary-Pancreatic Surgery, Graduate School of Medicine, Juntendo University, Tokyo, Japan
| | - Kiyohiko Omichi
- Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Hirofumi Ichida
- Department of Hepatobiliary-Pancreatic Surgery, Graduate School of Medicine, Juntendo University, Tokyo, Japan
| | - Tomoya Mizuno
- Department of Hepatobiliary-Pancreatic Surgery, Graduate School of Medicine, Juntendo University, Tokyo, Japan
| | - Ryuji Yoshioka
- Department of Hepatobiliary-Pancreatic Surgery, Graduate School of Medicine, Juntendo University, Tokyo, Japan
| | - Hiroshi Imamura
- Department of Hepatobiliary-Pancreatic Surgery, Graduate School of Medicine, Juntendo University, Tokyo, Japan
| | | | - Yosuke Inoue
- Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Yu Takahashi
- Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Akio Saiura
- Department of Hepatobiliary-Pancreatic Surgery, Graduate School of Medicine, Juntendo University, Tokyo, Japan. .,Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan.
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Anatomical resection is useful for the treatment of primary solitary hepatocellular carcinoma with predicted microscopic vessel invasion and/or intrahepatic metastasis. Surg Today 2021; 51:1429-1439. [PMID: 33564928 DOI: 10.1007/s00595-021-02237-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 01/02/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE The aim of this study was to evaluate anatomical resection (AR) versus non-AR for primary solitary hepatocellular carcinoma (HCC) with predicted microscopic vessel invasion (MVI) and/or microscopic intrahepatic metastasis (MIM). METHODS This retrospective study included 358 patients who underwent hepatectomy and had no evidence of MVI and/or MIM on preoperative imaging. The predictors of MVI and/or MIM were identified. The AR group (n = 222) and the non-AR group (n = 136) were classified by number of risk factor, and the survival rates were compared. RESULTS Microscopic vessel invasion and/or MIM were identified in 81 (22.6%) patients. A multivariate analysis showed that high des-gamma-carboxy prothrombin concentration [odds ratio (OR) 3.35], large tumor size (OR 3.16), and high aspartate aminotransferase concentration (OR 2.13) were significant predictors. The 5-year overall survival (OS) in the patients with zero, one, two, and three risk factors were 97.4%, 73.5%, 71.5%, and 65.5%, respectively. The OS of AR is superior to that of non-AR only in patients with one or two risk factors. CONCLUSION The present findings suggest that AR should be performed for patients with one or two risk factors, and that AR may prevent recurrence, as these patients are at risk of having MVI and/or MIM.
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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 2020; 28:844-853. [PMID: 32712886 DOI: 10.1245/s10434-020-08927-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 07/04/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Optimal choice of surgical procedure for hepatocellular carcinoma (HCC) remains inconclusive. This study seeks to investigate the oncological superiority of anatomic resection (AR) of the tumor-bearing portal territory and potential mechanism of survival benefit for patients undergoing AR. PATIENTS AND METHODS In 203 patients who underwent curative resection for primary solitary HCC measuring ≤ 5 cm in diameter, which was resectable either by AR or limited resection (non-AR), long-term outcomes were compared with propensity score adjustment. Advantages of AR in local tumor control and postprogression survival were then evaluated by a multivariate analysis and a Markov model. RESULTS The AR group showed better recurrence-free survival [hazard ratio (HR), 0.51; 95% CI, 0.28-0.91; P = 0.023), time-to-interventional failure (TIF) (HR, 0.08; 95% CI, 0.01-0.60; P = 0.014), and overall survival (HR, 0.11; 95% CI, 0.01-0.79, P = 0.029) than the non-AR group. Competing-risks regression revealed that AR significantly decreases local recurrence (HR, 0.13; 95% CI, 0.02-0.97; P = 0.047) and is correlated with smaller number and size of recurrent lesions, both of which were predictors for better TIF and postprogression survival. A Markov model demonstrated that annual transition rate from the early recurrence stage (i.e., curative-intent treatment indicated) to the intermediate stage (i.e., only palliative-intent treatment indicated) was significantly lower (9.0% versus 35.6%, P = 0.027) when AR was completed at the initial hepatectomy. CONCLUSIONS AR is oncologically advantageous for patients with primary solitary HCC. Initial choice of surgical procedure may have significant influence on the pattern of recurrence and postprogression clinical course that may affect overall survival of patients with HCC.
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Affiliation(s)
- Junichi Shindoh
- Hepatobiliary-pancreatic Surgery Division, Department of Gastroenterological Surgery, Toranomon Hospital, Minato-Ku, Tokyo, Japan. .,Okinaka Memorial Institute for Medical Disease, Tokyo, Japan.
| | - Yuta Kobayashi
- Hepatobiliary-pancreatic Surgery Division, Department of Gastroenterological Surgery, Toranomon Hospital, Minato-Ku, Tokyo, Japan
| | - Ryosuke Umino
- Hepatobiliary-pancreatic Surgery Division, Department of Gastroenterological Surgery, Toranomon Hospital, Minato-Ku, Tokyo, Japan
| | - Kazutaka Kojima
- Hepatobiliary-pancreatic Surgery Division, Department of Gastroenterological Surgery, Toranomon Hospital, Minato-Ku, Tokyo, Japan
| | - Satoshi Okubo
- Hepatobiliary-pancreatic Surgery Division, Department of Gastroenterological Surgery, Toranomon Hospital, Minato-Ku, Tokyo, Japan
| | - Masaji Hashimoto
- Hepatobiliary-pancreatic Surgery Division, Department of Gastroenterological Surgery, Toranomon Hospital, Minato-Ku, Tokyo, Japan
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Zhang J, Liu X, Zhang H, He X, Liu Y, Zhou J, Guo D. Texture Analysis Based on Preoperative Magnetic Resonance Imaging (MRI) and Conventional MRI Features for Predicting the Early Recurrence of Single Hepatocellular Carcinoma after Hepatectomy. Acad Radiol 2019; 26:1164-1173. [PMID: 30425000 DOI: 10.1016/j.acra.2018.10.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 10/10/2018] [Accepted: 10/12/2018] [Indexed: 12/28/2022]
Abstract
RATIONALE AND OBJECTIVES To investigate the value of texture analysis and conventional magnetic resonance imaging (MRI) features for predicting the early recurrence (ER) of single hepatocellular carcinoma (HCC) after hepatectomy. MATERIALS AND METHODS A total of 100 HCC patients were first divided into group A (tumor diameter ≤3 cm) and group B (tumor diameter >3 cm) and then classified into two subgroups with ER or nonearly recurrence. Textural parameters (skewness, kurtosis, uniformity, energy, entropy, and correlation) based on MR images and conventional MRI features were compared between the ER and nonearly recurrence subgroups. Predictive factors for ER were further assessed with multivariate logistic regression analysis. Receiver operating characteristic curve was performed to assess the predictive power. RESULTS There were 53 patients in group A and 47 patients in group B. On arterial phase analysis, tumors with ER displayed significantly lower uniformity and higher entropy in group A, and higher skewness and entropy in group B. On portal venous phase analysis, tumors with ER had significantly lower kurtosis and energy in group A, and higher entropy in group B. Irregular margin in groups A and B, and arterial peritumoral enhancement and capsule presence in group B were associated with ER. In multivariate logistic regression analysis, uniformity and entropy based on arterial phase images and irregular margin in group A, and skewness and entropy based on arterial phase images and arterial peritumoral enhancement in group B were independent predictors for ER. Entropy displayed higher predictive power for ER. CONCLUSION Texture analysis based on preoperative MRI are potential quantitative predictors of ER in HCC patients after hepatectomy, and may provide more information for preoperative treatment decision-making and follow up.
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Role of the anterior fissure vein in ventral or dorsal resection at Segment 8 of liver. Eur J Surg Oncol 2018. [DOI: 10.1016/j.ejso.2018.01.607] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
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Glantzounis GK, Paliouras A, Stylianidi MC, Milionis H, Tzimas P, Roukos D, Pentheroudakis G, Felekouras E. The role of liver resection in the management of intermediate and advanced stage hepatocellular carcinoma. A systematic review. Eur J Surg Oncol 2017; 44:195-208. [PMID: 29258719 DOI: 10.1016/j.ejso.2017.11.022] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Revised: 11/15/2017] [Accepted: 11/23/2017] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The ideal management for patients with intermediate and advanced stage hepatocellular carcinoma (HCC) is controversial. The main purpose of this systematic review is to examine the role of liver resection in patients with intermediate stage HCC (multinodular HCCs) and in advanced stage HCC [mainly patients with portal vein tumor thrombosis (PVTT)]. METHODS A systematic search of the literature was performed in Pud Med and the Cochrane Library from 01.01.2000 to 30.06.2016. RESULTS Twenty-three articles with 2412 patients with multinodular HCCs were selected. Also, 29 studies with 3659 patients with HCCs with macrovascular invasion were selected. In patients with multinodular HCCs the median post-operative morbidity was 25% and the 90-day mortality was 2.7%. The median survival was 37 months and the 5-year survival 35%. The 5-year survival was much better for patients with a number of HCCs ≤3 vs. HCCs >3 (49% vs. 23%). In patients with macrovascular invasion, who underwent hepatic resection, the median post-operative morbidity was 33% and the in-hospital mortality 2.7%. The median survival was 15 months. The 3 and 5year survival was 33% and 20% respectively. Moreover a significant difference in survival was noted according to PVTT stage: 5- year survival for distal PVTT, PVTT of the main intrahepatic PV branch and PVTT extending to the main PV was 45%, 19% and 14.5% respectively. CONCLUSIONS Liver resection in patients with multinodular HCCs and HCCs with PVTT offers satisfactory long-term survival and should be considered in selected patients.
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Affiliation(s)
- G K Glantzounis
- Department of Surgery, University Hospital of Ioannina and School of Medicine, University of Ioannina, 45 500, Ioannina, Greece.
| | - A Paliouras
- Department of Surgery, University Hospital of Ioannina and School of Medicine, University of Ioannina, 45 500, Ioannina, Greece
| | - M-C Stylianidi
- Department of Surgery, University Hospital of Ioannina and School of Medicine, University of Ioannina, 45 500, Ioannina, Greece
| | - H Milionis
- Department of Internal Medicine, University Hospital of Ioannina and School of Medicine, University of Ioannina, Ioannina, Greece
| | - P Tzimas
- Department of Anesthesia and Postoperative Intensive Care, University Hospital of Ioannina and School of Medicine, University of Ioannina, Ioannina, Greece
| | - D Roukos
- Department of Surgery, University Hospital of Ioannina and School of Medicine, University of Ioannina, 45 500, Ioannina, Greece
| | - G Pentheroudakis
- Department of Medical Oncology, University Hospital of Ioannina and School of Medicine, University of Ioannina, Ioannina, Greece
| | - E Felekouras
- 1st Department of Surgery, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
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Shindoh J, Nishioka Y, Hashimoto M. Bilateral anatomic resection of the ventral parts of the paramedian sectors of the liver with total caudate lobectomy for deeply/centrally located liver tumors: a new technique maximizing both oncological and surgical safety. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2017; 24:E10-E16. [DOI: 10.1002/jhbp.507] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Junichi Shindoh
- Hepatobiliary-pancreatic Surgery Division; Department of Gastroenterological Surgery; Toranomon Hospital; 2-2-2 Toranomon Minato-ku Tokyo 105-8470 Japan
| | - Yujiro Nishioka
- Hepatobiliary-pancreatic Surgery Division; Department of Gastroenterological Surgery; Toranomon Hospital; 2-2-2 Toranomon Minato-ku Tokyo 105-8470 Japan
| | - Masaji Hashimoto
- Hepatobiliary-pancreatic Surgery Division; Department of Gastroenterological Surgery; Toranomon Hospital; 2-2-2 Toranomon Minato-ku Tokyo 105-8470 Japan
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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. [PMID: 28499749 DOI: 10.1016/j.hpb.2017.04.010] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 04/05/2017] [Accepted: 04/09/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND The aim of this study was to determine the effect of anatomic resection (AR) versus non-anatomic resection (NAR) on recurrence rates in patients with hepatocellular carcinoma (HCC). METHODS Eligible patients were randomized to AR or NAR from January 2006 to July 2007 at a single center. The primary outcome was the 2-year recurrence-free survival (RFS). Secondary outcomes were postoperative complications, time to first recurrence, 1-, 3-, and 5-year RFS, and overall survival (OS). RESULTS Fifty-three (51%) and 52 (50%) patients underwent NAR and AR, respectively. A larger proportion of patients achieved margins ≥20 mm in the AR group (52% vs. 30%; P = 0.023). Complications (blood loss, transfusion requirement, and hospital stay) were similar between the two groups. Median follow-up was 33 (range, 2-77) months. Incidence of local recurrence at 2 years was 30% and 59% in the AR and NAR groups, respectively. Median time to first local recurrence in the AR group was significantly longer than in the NAR group (53 vs. 10 months, P = 0.010). There was no difference in overall RFS between the two groups (P = 0.290). DISCUSSION AR decreased the 2-year local recurrence rate and increased the time to first local recurrence compared to NAR in patients with HCC.
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Li SQ, Huang T, Shen SL, Hua YP, Hu WJ, Kuang M, Peng BG, Liang LJ. Anatomical versus non-anatomical liver resection for hepatocellular carcinoma exceeding Milan criteria. Br J Surg 2016; 104:118-127. [PMID: 27696379 DOI: 10.1002/bjs.10311] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Revised: 07/28/2016] [Accepted: 08/04/2016] [Indexed: 01/27/2023]
Abstract
BACKGROUND Liver resection is effective for hepatocellular carcinoma (HCC) exceeding the Milan criteria in selected patients. However, the benefit of anatomical resection (AR) versus non-anatomical resection (NAR) has not been clarified in this patient subgroup. This study aimed to compare outcomes between AR and NAR for HCC exceeding the Milan criteria. METHODS Data on consecutive patients with HCC exceeding the Milan criteria who underwent liver resection with curative intent over a recent 6-year interval were extracted from a prospective single-centre HCC database and examined retrospectively. The postoperative outcomes of patients were compared before and after propensity score matching. RESULTS Some 546 patients were included: 264 in the AR and 282 in the NAR group. In the original cohort, the AR group contained more patients with larger tumours, multiple tumours, macroscopic portal vein tumour thrombi, incomplete tumour capsules and microscopic vascular invasion. After propensity score matching, 177 pairs of patients were selected. The baseline data, including liver function and tumour burden, were similar in the matched groups. The 3-year recurrence-free survival rate was comparable between the matched NAR and AR groups (36·5 versus 28·5 per cent; P = 0·448). Similar results were observed for 3-year overall survival (57·5 versus 50·3 per cent; P = 0·385), recurrence patterns and early recurrence rates (57·6 per cent versus 59·9 per cent; P = 0·712). CONCLUSION AR and NAR achieved favourable and similar outcomes for HCC exceeding the Milan criteria in selected patients.
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Affiliation(s)
- S-Q Li
- Department of Liver Surgery, First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan Er Road, Guangzhou, 510080, China
| | - T Huang
- Department of Liver Surgery, First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan Er Road, Guangzhou, 510080, China
| | - S-L Shen
- Department of Liver Surgery, First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan Er Road, Guangzhou, 510080, China
| | - Y-P Hua
- Department of Liver Surgery, First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan Er Road, Guangzhou, 510080, China
| | - W-J Hu
- Department of Liver Surgery, First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan Er Road, Guangzhou, 510080, China
| | - M Kuang
- Department of Liver Surgery, First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan Er Road, Guangzhou, 510080, China
| | - B-G Peng
- Department of Liver Surgery, First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan Er Road, Guangzhou, 510080, China
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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. [PMID: 26505120 DOI: 10.1016/j.jhep.2015.10.015] [Citation(s) in RCA: 147] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Revised: 10/12/2015] [Accepted: 10/13/2015] [Indexed: 12/13/2022]
Abstract
BACKGROUND & AIMS Anatomic resection (AR) of the tumor-bearing portal territory has been reported to be associated with a decreased recurrence of hepatocellular carcinoma (HCC). However, because of the heterogeneity of the study populations, its oncologic advantage remains controversial. The objective of the present study was to determine the clinical advantage of AR for primary HCC, based on the data from a large prospective cohort treated under a constant surgical policy. METHODS In 209 Child-Pugh class A patients with primary, solitary HCC measuring ⩽5.0cm in diameter, which was resectable either by AR or limited resection (non-AR), the overall survival (OS) and disease-free survival (DFS) were compared with patients in whom complete AR was achieved and those who eventually ended up with non-AR after adjustment for the propensity scores to select AR. Advantages of AR in disease-specific survival and local recurrence were also evaluated by competing-risks regression to clarify the true oncologic impact of AR. RESULTS The AR group showed better DFS than the non-AR group (HR, 0.67; 95% CI, 0.45-0.99; p=0.046), while no significant difference was observed in OS (hazard ratio [HR], 0.82; 95% CI, 0.46-1.48; p=0.511). Competing-risks regression revealed that AR significantly decreases local recurrence (HR, 0.12; 95% CI, 0.05-0.30; p<0.001) and improves disease-specific survival (HR, 0.50; 95% CI, 0.28-0.90; p=0.020), while the other cause of death was highly influenced by patient age (>65years) (HR, 7.51; 95% CI, 2.16-26.04; p=0.002) and not associated with AR. CONCLUSION Complete removal of tumor-bearing portal territory decreases the risk of local recurrence and death from HCC.
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Affiliation(s)
- Junichi Shindoh
- Hepatobiliary-pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, Japan; Hepatobiliary-pancreatic Surgery Division, Department of Digestive Surgery, Toranomon Hospital, Japan
| | - Masatoshi Makuuchi
- Department of Hepato-biliary-pancreatic Surgery, Japan Red Cross Medical Center, Japan
| | - Yutaka Matsuyama
- Department of Biostatistics, Graduate School of Medicine, University of Tokyo, Japan
| | - Yoshihiro Mise
- Hepatobiliary-pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, Japan
| | - Junichi Arita
- Hepatobiliary-pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, Japan
| | - Yoshihiro Sakamoto
- Hepatobiliary-pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, Japan
| | - Kiyoshi Hasegawa
- Hepatobiliary-pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, Japan
| | - Norihiro Kokudo
- Hepatobiliary-pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, Japan.
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Okamura Y, Ito T, Sugiura T, Mori K, Uesaka K. Anatomic versus nonanatomic hepatectomy for a solitary hepatocellular carcinoma : a case-controlled study with propensity score matching. J Gastrointest Surg 2014; 18:1994-2002. [PMID: 25213582 DOI: 10.1007/s11605-014-2646-6] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Accepted: 08/25/2014] [Indexed: 02/06/2023]
Abstract
BACKGROUND It remains controversial whether anatomical resection (AR) improves the prognosis for hepatocellular carcinoma (HCC) or not. To our knowledge, there have been a few well-matched studies about this issue. The aim of the present study was to compare the recurrence-free survival of AR versus nonanatomical resection (NAR) for a solitary HCC using propensity score matching. METHODS The present study included 236 patients who had a solitary HCC without macroscopic vessel thrombosis. Those patients were divided into AR (n = 139) and NAR (n = 97) groups. A propensity score matching was performed to minimize the effect of potential confounders. RESULTS Sixty-four patients from each group were matched. Preoperative confounding factors were balanced between the two groups. The median recurrence-free survival times in the AR and NAR groups were 33.8 and 30.8 months, respectively (P = 0.520). There were no significant differences in the intrahepatic recurrence pattern (P = 0.097). Operative procedure was not a significant risk factor for recurrence in both uni- and multivariate analyses. CONCLUSIONS This case-matching study using a propensity score shows that there is no superiority of AR to NAR relevant to the recurrence-free survival in patients with a single HCC.
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Affiliation(s)
- Yukiyasu Okamura
- Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center Hospital, Shizuoka, Japan,
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Pugalenthi A, Cutter CS, Fong Y. Current treatment for small (< 5 cm) hepatocellular carcinoma: evolving roles for ablation and resection. Adv Surg 2014; 48:97-114. [PMID: 25293610 DOI: 10.1016/j.yasu.2014.05.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Abstract
The main methods of treatment for hepatocellular carcinoma (HCC) in Japan are hepatic resection, radiofrequency ablation (RFA) and transcatheter arterial chemoembolization (TACE). Meticulous follow up is then undertaken to check for recurrence, which is treated using repeated RFA or TACE. Hepatic arterial infusion chemotherapy has been introduced as treatment for advanced HCC, and the molecular-targeted drug sorafenib is also now available. Rigorous medical care using these treatment methods and early diagnosis mean that the prognosis for HCC in Japan is the best in the world. This paper reviews the treatment strategies for HCC in Japan.
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Affiliation(s)
- Tatsuya Yamashita
- Department of Gastroenterology, Kanazawa University, Kanazawa, Ishikawa, Japan
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Shindoh J, Seyama Y, Umekita N. Three-dimensional staining of liver segments with an ultrasound contrast agent as an aid to anatomic liver resection. J Am Coll Surg 2012; 215:e5-10. [PMID: 22683072 DOI: 10.1016/j.jamcollsurg.2012.05.017] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2012] [Revised: 05/16/2012] [Accepted: 05/16/2012] [Indexed: 12/16/2022]
Affiliation(s)
- Junichi Shindoh
- Department of Surgery, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan.
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