Annals of gastroenterological surgery · 2025
Comparison of Anatomical and Non-Anatomical Resection in Low Microvascular Invasion Risk Solitary Hepatocellular Carcinoma ≤ 5 cm.
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Iseda Norifumi, Itoh Shinji, Yugawa Kyohei, Yoshiya Shohei, Motomura Takashi, Toshima Takeo, Yoshizumi Tomoharu
Аннотация
BACKGROUND: The role of anatomical resection (AR) in hepatocellular carcinoma (HCC) remains controversial, particularly for tumors ≤ 5 cm without vascular invasion. We aimed to evaluate the long-term outcomes of AR versus non-anatomical resection (NAR) in solitary HCC presumed negative for microvascular invasion (MVI) and intrahepatic metastasis (IM).
METHODS: We retrospectively analyzed 303 patients with solitary HCC who underwent hepatectomy between 2002 and 2019. Predictive factors for MVI and IM were identified, and 214 patients with solitary HCC ≤ 5 cm and predicted absence of MVI and IM were further analyzed. We compared the perioperative and oncological outcomes between the AR (n = 94) and NAR (n = 120) groups. Subsequently, we conducted propensity score matching (n = 41 per group) and performed subgroup analyses based on tumor size.
RESULTS: Des-γ-carboxy prothrombin > 150 mAU/mL was identified as an independent predictor for MVI and IM. Compared with the NAR group, the AR group had a significantly longer operative time, greater blood loss, and higher rate of complications, but showed no significant differences in recurrence-free survival and overall survival. Recurrence-free survival and overall survival remained comparable between the two groups after propensity score matching. Subgroup analyses by tumor size (0-2.0 and 2.1-5.0 cm) showed no prognostic advantage for AR over NAR.
CONCLUSIONS: For solitary HCC ≤ 5 cm without predicted MVI and IM, NAR and AR result in comparable long-term outcomes. The resection strategy should prioritize remnant liver function over anatomical extent.
METHODS: We retrospectively analyzed 303 patients with solitary HCC who underwent hepatectomy between 2002 and 2019. Predictive factors for MVI and IM were identified, and 214 patients with solitary HCC ≤ 5 cm and predicted absence of MVI and IM were further analyzed. We compared the perioperative and oncological outcomes between the AR (n = 94) and NAR (n = 120) groups. Subsequently, we conducted propensity score matching (n = 41 per group) and performed subgroup analyses based on tumor size.
RESULTS: Des-γ-carboxy prothrombin > 150 mAU/mL was identified as an independent predictor for MVI and IM. Compared with the NAR group, the AR group had a significantly longer operative time, greater blood loss, and higher rate of complications, but showed no significant differences in recurrence-free survival and overall survival. Recurrence-free survival and overall survival remained comparable between the two groups after propensity score matching. Subgroup analyses by tumor size (0-2.0 and 2.1-5.0 cm) showed no prognostic advantage for AR over NAR.
CONCLUSIONS: For solitary HCC ≤ 5 cm without predicted MVI and IM, NAR and AR result in comparable long-term outcomes. The resection strategy should prioritize remnant liver function over anatomical extent.