Comparison of the outcomes between an anatomical subsegmentectomy and a non-anatomical minor hepatectomy for single hepatocellular carcinomas based on a Japanese nationwide survey.
BACKGROUND
Although a surgical resection is an important modality for the treatment of hepatocellular carcinoma (HCC), the impact of the operative method on both the patient survival and disease-free survival (DFS) still remains controversial.


METHODS
Using a nationwide Japanese database, 72,744 patients with HCC who underwent a curative liver resection between 1994 and 2001 were divided into two groups based on whether an anatomical subsegmentectomy (AS) or a non-anatomical minor hepatectomy (MH) was performed. A total of 5,781 patients with single HCCs were selected for the study and divided into 3 subgroups based on the size of the HCCs (less than 2 cm, 2 to 5 cm, and greater than 5 cm in diameter). An AS was performed for 2,267 patients while an MH was performed for 3,514 patients.


RESULTS
The overall DFS was significantly better after an AS (P = .0089). When the patients were stratified according to the size of the HCC, a better DFS was seen in the patients with HCC from 2 to 5 cm after an AS (P < .0005). Further stratification according to liver damage did not show any significant differences between an AS and an MH.


CONCLUSIONS
An AS is therefore recommended, especially when the size of HCC ranges from 2 to 5 cm.
Eguchi
Susumu
S
Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan. sueguchi@nagasaki-u.acjp
Kanematsu
Takashi
T
Arii
Shigeki
S
Okazaki
Masatoshi
M
Okita
Kiwamu
K
Omata
Masao
M
Ikai
Iwao
I
Kudo
Masatoshi
M
Kojiro
Masamichi
M
Makuuchi
Masatoshi
M
Monden
Morito
M
Matsuyama
Yutaka
Y
Nakanuma
Yasuni
Y
Takayasu
Kenichi
K
D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D019538:Health Care Surveys; D006498:Hepatectomy / Q000379:methods* / Q000706:statistics & numerical data; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008113:Liver Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D016019:Survival Analysis; D016896:Treatment Outcome