title: Clinical analysis of anatomical resection for the treatment of hepatocellular carcinoma based on the stratification of liver function.
abstract: BACKGROUND
  This study aimed to clarify the efficacy of anatomical resection (AR) for the treatment of hepatocellular carcinoma (HCC) compared with that of nonanatomical resection (NAR) based on the stratification of liver function (LF).
  
  
  METHODS
  The clinical records of 174 patients with a single HCC, 2-5 cm in diameter and without macroscopic vascular invasion, were analyzed. AR was performed in 132 patients and NAR was performed in 42 patients. The indocyanine green retention rate at 15 min (ICGR15) of the 78 patients classified as the good-LF group was 10-20 % and the ICGR15 of the 54 patients classified as the poor-LF group was 20-40 %.
  
  
  RESULTS
  The 5-year overall survival (OS) and disease-free survival rates of the 174 patients were 67.6 and 33.4 %, respectively. Cox proportional hazard analysis identified ICGR15 ≥ 20 %, liver cirrhosis, α-fetoprotein ≥ 100 mg/dL, and infiltrating growth as independent prognostic factors. Liver cirrhosis was significantly less frequent in patients who underwent AR than in patients who underwent NAR (52 vs. 79 %, p = 0.002). In the subgroup analysis of the good-LF group, there were no significant differences in 5-year OS after AR and NAR (73.3 vs. 65.2 %, p = 0.857). By contrast, in the subgroup analysis of the poor-LF group, the 5-year OS after AR was significantly worse than after NAR (45.3 vs. 77.4 %, p = 0.044).
  
  
  CONCLUSIONS
  In patients with an ICGR15 ≥ 20 %, we recommend NAR rather than AR for the treatment of a solitary 2-5-cm-diameter HCC and without macroscopic vascular invasion.
authors.affiliation: Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto, 6028566, Japan, yamayu-1@koto.kpu-m.ac.jp.
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Yamamoto
authors.forename: Hisashi
authors.initials: H
authors.lastname: Ikoma
authors.forename: Ryo
authors.initials: R
authors.lastname: Morimura
authors.forename: Hirotaka
authors.initials: H
authors.lastname: Konishi
authors.forename: Yasutoshi
authors.initials: Y
authors.lastname: Murayama
authors.forename: Shuhei
authors.initials: S
authors.lastname: Komatsu
authors.forename: Atsushi
authors.initials: A
authors.lastname: Shiozaki
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Kuriu
authors.forename: Takeshi
authors.initials: T
authors.lastname: Kubota
authors.forename: Masayoshi
authors.initials: M
authors.lastname: Nakanishi
authors.forename: Daisuke
authors.initials: D
authors.lastname: Ichikawa
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Fujiwara
authors.forename: Kazuma
authors.initials: K
authors.lastname: Okamoto
authors.forename: Chouhei
authors.initials: C
authors.lastname: Sakakura
authors.forename: Toshiya
authors.initials: T
authors.lastname: Ochiai
authors.forename: Eigo
authors.initials: E
authors.lastname: Otsuji
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000473:pathology* / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D006498:Hepatectomy; D006801:Humans; D008111:Liver Function Tests; D008113:Liver Neoplasms / Q000473:pathology* / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies