Anatomic versus nonanatomic resection in cirrhotic patients with early hepatocellular carcinoma

• 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
• ISSN: 0039-6060; 1532-7361
• DOI: 10.1016/j.surg.2013.10.009

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 (