Anatomic versus nonanatomic resection in cirrhotic patients with early hepatocellular carcinoma.
BACKGROUND
Whether anatomic resection (AR) for hepatocellular carcinoma (HCC) can really confer a survival advantage over non-AR (NAR), especially for cirrhotic patients, remains unclear.


METHODS
Prospectively collected data of 543 cirrhotic patients in Child-Pugh class A submitted to AR (n = 228) versus NAR (n = 315) for early HCC in an Eastern (n = 269) and a Western (n = 274) surgical unit, were reviewed. To control for confounding variable distributions, a 1-to-1 propensity score match was applied to compare AR and NAR outcomes (n = 298).


RESULTS
The 5-year recurrence-free and overall survivals of the 543 patients were 32.3% and 60.0%, respectively, without differences between the 2 centers (P = .635 and .479, respectively). AR conferred better overall and recurrence-free survival than NAR (P = .009 and .041, respectively), but NAR patients suffered from significantly worse hepatic dysfunction. After 1-to-1 match, AR (n = 149) and NAR (n = 149) patients had similar covariate distributions. In this matched sample, AR still conferred better recurrence-free survival over NAR (P = .044) but the beneficial effect of AR was limited to the reduction of early recurrence (<2 years) of poorly differentiated tumors and of tumors with microvascular invasion (P < .05), resulting in better overall survival (P = .018).


CONCLUSIONS
In cirrhotic patients, AR for early HCC can lead to a lower early recurrence rate in tumors with unfavorable tumor features, whereas NAR will not worsen the recurrence rate in well/moderately differentiated tumors or in the absence of microvascular invasion.
Liver and Multiorgan Transplant Unit, S. Orsola Hospital, Alma Mater Studiorum - University of Bologna, Bologna, Italy. Electronic address: aleqko@libero.it.
Alessandro
A
Cucchetti
Eastern Hepatobiliary Surgery Hospital, Shanghai, China.
Guo-Liang
GL
Qiao
Liver and Multiorgan Transplant Unit, S. Orsola Hospital, Alma Mater Studiorum - University of Bologna, Bologna, Italy.
Matteo
M
Cescon
Eastern Hepatobiliary Surgery Hospital, Shanghai, China.
Jun
J
Li
Eastern Hepatobiliary Surgery Hospital, Shanghai, China.
Yong
Y
Xia
Liver and Multiorgan Transplant Unit, S. Orsola Hospital, Alma Mater Studiorum - University of Bologna, Bologna, Italy.
Giorgio
G
Ercolani
Eastern Hepatobiliary Surgery Hospital, Shanghai, China.
Feng
F
Shen
Liver and Multiorgan Transplant Unit, S. Orsola Hospital, Alma Mater Studiorum - University of Bologna, Bologna, Italy.
Antonio Daniele
AD
Pinna
D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000150:complications / Q000401:mortality / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D008103:Liver Cirrhosis / Q000209:etiology*; D008113:Liver Neoplasms / Q000150:complications / Q000401:mortality / Q000601:surgery*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D057216:Propensity Score; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome