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)...

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Bibliographic Details
Published in:Surgery 2014-03, Vol.155 (3), p.512-521
Main Authors: Cucchetti, Alessandro, MD, Qiao, Guo-Liang, MD, Cescon, Matteo, MD, PhD, Li, Jun, MD, Xia, Yong, MD, Ercolani, Giorgio, MD, Shen, Feng, MD, Pinna, Antonio Daniele, MD, PhD
Format: Article
Language:English
Subjects:
Aged
Carcinoma, Hepatocellular - complications
Carcinoma, Hepatocellular - mortality
Carcinoma, Hepatocellular - surgery
Female
Follow-Up Studies
Hepatectomy - methods
Humans
Liver Cirrhosis - etiology
Liver Neoplasms - complications
Liver Neoplasms - mortality
Liver Neoplasms - surgery
Logistic Models
Male
Middle Aged
Multivariate Analysis
Propensity Score
Retrospective Studies
Surgery
Survival Analysis
Treatment Outcome
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Summary: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 (
ISSN:0039-6060
1532-7361
DOI:10.1016/j.surg.2013.10.009