title: Do patients with small solitary hepatocellular carcinomas without macroscopically vascular invasion require anatomic resection? Propensity score analysis.
abstract: BACKGROUND
  The benefits of anatomic resection in patients with small (<5 cm), solitary hepatocellular carcinomas remain unclear. Outcomes were therefore evaluated in patients who underwent anatomic resection or nonanatomic resection of small solitary hepatocellular carcinomas.
  
  
  METHODS
  Factors affecting overall survival and disease-free survival were investigated in 330 patients who underwent curative hepatectomy for solitary (≤5 cm) hepatocellular carcinomas without macroscopic vascular invasion. In addition, a propensity score matching model with 330 patients was constructed to overcome bias, with subgroups analyzed by tumor diameter (<3 cm and 3-5 cm).
  
  
  RESULTS
  ICG-R15 ≥25% was confirmed as being independently associated with poorer overall survival and disease-free survival. One-to-one matching of preoperative characteristics yielded 72 pairs of patients receiving anatomic resection and nonanatomic resection, with long-term outcomes, including overall survival and disease-free survival, being similar in these 2 groups. Subgroup analysis showed that, in patients with tumors <3 cm in diameter, short-term outcomes were better in the nonanatomic resection group than in the anatomic resection group, including significantly reduced operation time (P = .02), blood loss (P = .01), blood transfusion (P < .01), complications (particularly bile leakage and abdominal abscess) (P = .04), and postoperative hospital stay (P < .01).
  
  
  CONCLUSIONS
  Anatomic resection was not superior to nonanatomic resection in survival outcomes in patients with solitary small hepatocellular carcinomas without macroscopic vascular invasion. Rather, postoperative short-term outcomes were more favorable with nonanatomic resection.
authors.affiliation: Department of General and Gastroenterological Surgery, Osaka Medical College, Takatsuki, Osaka, Japan. Electronic address: sur122@poh.osaka-med.ac.jp.
authors.forename: Fumitoshi
authors.initials: F
authors.lastname: Hirokawa
authors.affiliation: Department of Hepato-Biliary-Pancreatic Surgery, Osaka City University Graduate School of Medicine, Osaka, Osaka, Japan.
authors.forename: Shoji
authors.initials: S
authors.lastname: Kubo
authors.affiliation: Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan.
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Nagano
authors.affiliation: Department of Surgery, Kinki University School of Medicine, Sayama, Osaka, Japan.
authors.forename: Takuya
authors.initials: T
authors.lastname: Nakai
authors.affiliation: Department of Surgery, Hirakata Hospital, Kansai Medical University, Hirakata, Osaka, Japan.
authors.forename: Masaki
authors.initials: M
authors.lastname: Kaibori
authors.affiliation: Department of General and Gastroenterological Surgery, Osaka Medical College, Takatsuki, Osaka, Japan.
authors.forename: Michihiro
authors.initials: M
authors.lastname: Hayashi
authors.affiliation: Department of Hepato-Biliary-Pancreatic Surgery, Osaka City University Graduate School of Medicine, Osaka, Osaka, Japan.
authors.forename: Shigekazu
authors.initials: S
authors.lastname: Takemura
authors.affiliation: Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Wada
authors.affiliation: Department of Surgery, Kinki University School of Medicine, Sayama, Osaka, Japan.
authors.forename: Yasuyuki
authors.initials: Y
authors.lastname: Nakata
authors.affiliation: Department of Surgery, Hirakata Hospital, Kansai Medical University, Hirakata, Osaka, Japan.
authors.forename: Kosuke
authors.initials: K
authors.lastname: Matsui
authors.affiliation: Department of Surgery, Hirakata Hospital, Kansai Medical University, Hirakata, Osaka, Japan.
authors.forename: Morihiko
authors.initials: M
authors.lastname: Ishizaki
authors.affiliation: Department of General and Gastroenterological Surgery, Osaka Medical College, Takatsuki, Osaka, Japan.
authors.forename: Kazuhisa
authors.initials: K
authors.lastname: Uchiyama
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000601:surgery*; D005260:Female; D006498:Hepatectomy / Q000379:methods* / Q000706:statistics & numerical data; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008113:Liver Neoplasms / Q000401:mortality / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000601:surgery*; D057216:Propensity Score; D012189:Retrospective Studies