title: Step classification is useful for the determination of indications for systematized hepatectomy in hepatocellular carcinoma.
abstract: OBJECTIVE
  The effectiveness of systematized hepatectomy with transection of Glisson's pedicle at the hepatic hilus has not been clarified in detail in relation to previous staging systems. Outcomes after systematized hepatectomy in patients with hepatocellular carcinoma (HCC) were examined in relation to our new staging system.
  
  
  METHODS
  We retrospectively studied 955 patients with HCC who underwent hepatectomy from 1989 through 2002. We classified patients with HCC into four groups according to the pathological findings (pathological step [p-step]): p-step 1, HCC with absence of vascular invasion and absence of intrahepatic metastasis; p-step 2, HCC with vascular invasion and/or intrahepatic metastasis; p-step 3, HCC with major vascular invasion and/or intrahepatic metastasis to both lobes of the liver; and p-step 4, HCC with distant metastasis, including lymph node metastasis or ruptured HCC). We separated the liver into three segments (Takasaki's liver segments). Systematized hepatectomy was classified as systematized segmentectomy or larger resection, and partial segmentectomy. Segmentectomy refers to resection of one of Takasaki's segments.
  
  
  RESULTS
  Systematized segmentectomy did not affect recurrence-free survival, by univariate analysis, in patients with p-step 1, p-step 3, or p-step 4. However, systematized segmentectomy or larger resection was significantly associated with patient recurrence-free survival, by univariate analysis, in patients with p-step 2. Multivariate analysis also showed systematized segmentectomy or larger resection as a significant independent prognostic factor in patients with p-step 2.
  
  
  CONCLUSIONS
  Systematized segmentectomy is suitable for patients with p-step 2 HCC according to this step classification.
authors.affiliation: Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, 8-1 Kawada, Shinjuku-ku, Tokyo 162-8666, Japan.
authors.forename: Shun-Ichi
authors.initials: S
authors.lastname: Ariizumi
authors.forename: Masakazu
authors.initials: M
authors.lastname: Yamamoto
authors.forename: Takehito
authors.initials: T
authors.lastname: Ohtsubo
authors.forename: Hideo
authors.initials: H
authors.lastname: Katsuragawa
authors.forename: Satoshi
authors.initials: S
authors.lastname: Katagiri
authors.forename: Ken
authors.initials: K
authors.lastname: Takasaki
mesh_terms: D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D016896:Treatment Outcome