Prognostic impact of anatomical resection on early and late intrahepatic recurrence in patients with hepatocellular carcinoma.
OBJECTIVE
Little has been addressed regarding the impact of the type of resection, which can be anatomical or nonanatomical, for patients with hepatocellular carcinoma (HCC), from the viewpoint of early (< or =2-year) and late (>2-year) intrahepatic recurrence. The aim of the present study was to investigate this issue.


METHODS
Between 1990 and 2004, we performed 365 potentially curative liver resections. Among these, 233 patients with a solitary tumor were the subjects of this study. They were classified into two groups: anatomical resection (n = 106) and nonanatomical resection (n = 127). We evaluated the following outcomes: (1) early and late recurrence rates; (2) topography of the recurrent tumors; and (3) risk factors for early recurrence.


RESULTS
The early recurrence rate after anatomical resection was significantly lower than that after nonanatomical resection: recurrence rates at 1 and 2 years were 13.8% and 29.8%, respectively, in the former group; while they were 22.6% and 46.3%, respectively, in the latter group (P = 0.01; log-rank test). However, late recurrence rates were similar in the two groups (P = 0.36). Local recurrence was observed in 25 of the 89 patients with intrahepatic recurrence after nonanatomical resection (28%), whereas it was observed in 3 of the 64 patients with intrahepatic recurrence after anatomical resection (5%), showing a significantly lower local recurrence rate in the anatomical resection group (P = 0.0002). Cox multivariate analysis identified the type of resection employed as one of the variables contributing to early HCC recurrence (nonanatomical resection: hazard ratio, 1.84; 95% confidence interval [CI], 1.01-3.37).


CONCLUSIONS
Anatomical resection would be a more appropriate strategy than nonanatomical resection for preventing early intrahepatic recurrence in patients with solitary HCC. However, the type of resection has no significant influence on late recurrence.
Kobayashi
Akira
A
First Department of Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Japan.
Miyagawa
Shinichi
S
Miwa
Shiro
S
Nakata
Takenari
T
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000601:surgery*; D005260:Female; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control*; D011379:Prognosis; D012307:Risk Factors; D013997:Time Factors; D055815:Young Adult