Anatomic Resection Group Research Articles

Efficacy and safety of anatomic resection versus nonanatomic resection in patients with hepatocellular carcinoma: A systemic review and meta-analysis.

BackgroundThe surgical decision of performing anatomic resection (AR) or nonanatomic resection (NAR) in patients with hepatocellular carcinoma remains controversial. The aim of the current study is to conduct a meta-analysis on published results to compare surgical outcomes after AR and NAR.MethodsA comprehensive search of the Pubmed, Ovid-Medline, Embase, Cochrane library, and Science Citation indexes was performed. Overall and disease free survival (DFS), perioperative mortality and morbidity were the main outcomes. The meta-analysis was performed using Revman 5.3 statistical software, and the results are expressed as the relative risk (RR) or weighted mean differences with 95% of confidence intervals.ResultsAfter application of the exclusion and inclusion criteria, 25 studies published between 1996~2015 that compared outcomes after AR and NAR in patients with HCC were identified. A total of 10216 patients were included in the meta-analysis, 4576 in the AR group and 5640 in the NAR group. Liver cirrhosis was found in 54.8% (range from 18.8% to 100%) of patients in the AR group and 67.8% (range from 34.3% to 100%) of patients in the NAR group, resulting in a RR of 0.45 (I2 = 18%, fixed model, 95% CI 0.39–0.52; Z = 10.31; P = <0.00001). The meta-analysis revealed a statistically significant 5-year survival (RR of 1.10, 95% CI 1.03–1.17; Z = 2.92, P = 0.004) and DFS (RR: 1.33, 95% CI 1.18–1.51; Z = 4.46, P <0.00001) advantage for patients undergoing AR resection compared to NAR. In regards to safety, no statistical significance was found in mortality and morbidity between the two groups. Eight studies including 1812 patients with small (<5 cm) solitary HCC indicated a better 5-year DFS in the AR group (41.4%) than in the NAR group (28.6%), with a RR of 1.32 (I2 = 42, fixed model, 95%CI: 1.15–1.52, Z = 3.86, P = 0.0001).ConclusionThe current study demonstrates better surgical outcomes after AR than NAR in patients with HCC. Therefore, AR is recommended in resectable HCC, especially with small (<5 cm) solitary tumours.

A Meta-analysis comparing the effect of anatomical resection vs. non-anatomical resection on the long-term outcomes for patients undergoing hepatic resection for hepatocellular carcinoma

BackgroundThis study aimed to compare the outcomes of patients undergoing anatomical resection (AR) versus non-anatomical resection (NAR) for hepatocellular carcinoma (HCC) from the published comparative studies within the literatures. MethodsA meta-analysis of studies published from 2001 to 2010 were conducted using RevMan 5.0. Measured outcomes were morbidity, mortality, recurrence and 5 year overall (OS) and disease free (DFS) survival. ResultsSeventeen observational studies involving 3129 patients were analyzed: 1626 (52%) in AR group and 1503 (48%) in NAR group. The 5-year OS (RR, 1.18; 95% CI, 1.03–1.36; P = 0.018) and DFS (RR, 1.56; 95% CI, 1.23–1.97; P < 0.001) were significantly greater in the AR group than the NAR group, while the overall recurrence was significantly lower (RR, 0.84; 95% CI, 0.75–0.94; P < 0.001). There were no significant differences in mortality (RR, 1.00; 95% CI, 0.80–1.25; P = 0.980) or morbidity (OR, 0.97; 95% CI, 0.48–1.99; P = 0.943) between the AR and NAR groups. ConclusionAR for HCC is superior to NAR considering its higher 5-year OS and DFS rates and lower overall recurrence rate. Heterogeneity detection within the analysis suggests these results should be interpreted with caution and further well designed studies are required to address this issue.

Recurrence of Barcelona Clinic Liver Cancer Stage A Hepatocellular Carcinoma After Hepatectomy

BackgroundThe Barcelona Clinic Liver Cancer (BCLC) staging system is widely used to classify hepatocellular carcinoma (HCC). This study was performed to investigate the prognostic factors for patients with BCLC stage A HCC after R0 hepatectomy. MethodsA total of 592 patients with BCLC stage A HCC following R0 hepatectomy from 1997-2012 were enrolled in this study. Kaplan-Meier analysis and Cox regression were used to analyze the risk factors associated with recurrence. Receiver operating characteristic curves were used to establish a new scoring system to evaluate the independent risk factors for recurrence. Furthermore, subgroup analyses were performed to evaluate surgical margins on tumor recurrence between the anatomic and nonanatomic resection group. ResultsIndependent risk factors for BCLC stage A HCC recurrence were preoperative alanine transaminase >40U/L, liver cirrhosis, surgical margin <5mm, nonanatomic resection and maximum tumor diameter >5cm. Based on these 5 risk factors, we established a new scoring system, named “HCC recurrence scoring system.” Patients with a high score (≥3 points, 1 point for each factor) composed the high recurrence risk group. Moreover, the subgroup analyses demonstrated that different surgical margins had no significant effect on tumor recurrence in the anatomic resection group (P = 0.408), while it had a significant effect in the nonanatomic resection group (P = 0.000). ConclusionsFor patients with BCLC stage A with scores ≥3 points, close postoperative follow-up and positive measures to prevent recurrence are particularly important. Anatomic resection is preferred for patients with BCLC stage A. Adequate surgical margins are necessary for patients with poor liver function.

A double blinded prospective randomized trial comparing the effect of anatomic versus non-anatomic resection on hepatocellular carcinoma recurrence

BackgroundThe aim of this study was to determine the effect of anatomic resection (AR) versus non-anatomic resection (NAR) on recurrence rates in patients with hepatocellular carcinoma (HCC). MethodsEligible patients were randomized to AR or NAR from January 2006 to July 2007 at a single center. The primary outcome was the 2-year recurrence-free survival (RFS). Secondary outcomes were postoperative complications, time to first recurrence, 1-, 3-, and 5-year RFS, and overall survival (OS). ResultsFifty-three (51%) and 52 (50%) patients underwent NAR and AR, respectively. A larger proportion of patients achieved margins ≥20 mm in the AR group (52% vs. 30%; P = 0.023). Complications (blood loss, transfusion requirement, and hospital stay) were similar between the two groups. Median follow-up was 33 (range, 2–77) months. Incidence of local recurrence at 2 years was 30% and 59% in the AR and NAR groups, respectively. Median time to first local recurrence in the AR group was significantly longer than in the NAR group (53 vs. 10 months, P = 0.010). There was no difference in overall RFS between the two groups (P = 0.290). DiscussionAR decreased the 2-year local recurrence rate and increased the time to first local recurrence compared to NAR in patients with HCC.

Sublobar resection for clinical stage I nonsmall cell lung cancers

Aim: We investigated outcomes of sublobar resection in patients with clinical early-stage nonsmall cell lung cancers. Patients and Methods: Patients who underwent surgical resection between January 2002 and June 2013 were reviewed. The clinical data, surgical approach, and outcome were analyzed with mean follow-up of 108 months. Results: Of 597 patients, 108 (18.1%) underwent sublobar resection. The 5-year overall survival (OS) and disease-free survival rate for this group were 76.2% and 70.3%, respectively, compared with 79.7% and 73.0% for those undergoing anatomic resection ( P = 0.709 and 0.618). After stratifying for tumor size P = 0.760 and 0.868). The local recurrence rate was 3% in the sublobar resection group and 8.5% in the anatomic resection group. There were no significant differences in age, gender, histopathology type, maximum standard uptake value, lymphovascular space invasion, visceral pleural invasion, and epidermal growth factor receptor status, except in the grade of tumor differentiation and numbers of dissected lymph nodes: 13.16 ± 6.62 in the anatomic resection group and 7.34 ± 4.91 in the sublobar resection group ( P Conclusions: The oncologic outcomes of sublobar resection were similar to anatomic resection in these patients; lymph node sampling might not compromise surgical outcomes. Further large-scale studies are necessary to clarify the difference in clinical outcome between segmentectomy and wedge resection.

Nonanatomical resection is comparable with anatomical resection in solitary hepatocellular carcinoma

Anatomical resection (AR) is superior to nonanatomical resection (NAR) in theory, but the actual clinical benefit of AR for hepatocellular carcinoma (HCC) is controversial due to the substantial heterogeneity of HCC. Here, we retrospectively compared AR and NAR outcomes for solitary hepatocellular carcinoma (HCC) <5 cm in the right posterior section (RPS) and investigated the risk factors for HCC recurrence and liver-related mortality.The study included 99 consecutive patients who underwent curative surgical resection of an HCC in the RPS (S6 and S7) between January 2003 and December 2009. Each patient had a solitary HCC <5 cm and a noncirrhotic liver.The median estimated blood loss during operation and median operative time were significantly worse in the AR group. In addition, the median tumor size and incidence of microvascular invasion were significantly worse in the AR group. The 1-, 3-, and 5-year disease-free survival rates were 74.1%, 66.3%, and 58.2% in the AR group and 84.7%, 64.4%, and 48.2% in the NAR group, respectively (P = 0.172). The corresponding liver-related overall survival rates were 96.3%, 84.7%, and 77.0% in the AR group and 97.2%, 90.1%, and 88.7% in the NAR group, respectively (P = 0.335). NAR was not associated with HCC recurrence or liver-related mortality in multivariate analysis.The outcomes of NAR for a solitary HCC <5 cm in the RPS are comparable to those achieved with AR with respect to long-term liver-related overall survival and disease-free survival.

Anatomical versus non-anatomical liver resection for hepatocellular carcinoma exceeding Milan criteria

Liver resection is effective for hepatocellular carcinoma (HCC) exceeding the Milan criteria in selected patients. However, the benefit of anatomical resection (AR) versus non-anatomical resection (NAR) has not been clarified in this patient subgroup. This study aimed to compare outcomes between AR and NAR for HCC exceeding the Milan criteria. Data on consecutive patients with HCC exceeding the Milan criteria who underwent liver resection with curative intent over a recent 6-year interval were extracted from a prospective single-centre HCC database and examined retrospectively. The postoperative outcomes of patients were compared before and after propensity score matching. Some 546 patients were included: 264 in the AR and 282 in the NAR group. In the original cohort, the AR group contained more patients with larger tumours, multiple tumours, macroscopic portal vein tumour thrombi, incomplete tumour capsules and microscopic vascular invasion. After propensity score matching, 177 pairs of patients were selected. The baseline data, including liver function and tumour burden, were similar in the matched groups. The 3-year recurrence-free survival rate was comparable between the matched NAR and AR groups (36·5 versus 28·5 per cent; P = 0·448). Similar results were observed for 3-year overall survival (57·5 versus 50·3 per cent; P = 0·385), recurrence patterns and early recurrence rates (57·6 per cent versus 59·9 per cent; P = 0·712). AR and NAR achieved favourable and similar outcomes for HCC exceeding the Milan criteria in selected patients.

Clinical factors that affect the outcomes after anatomical versus non-anatomical resection for hepatocellular carcinoma.

For hepatocellular carcinoma (HCC), the superiority of anatomical resection (AR) over non-anatomical resection (NR) is still controversial. In this study, we assessed the potential benefits of AR for HCC. We enrolled 173 consecutive patients with HCC who underwent hepatectomy in our hospital from August 2003 to May 2013 and compared the outcomes for the AR group (n=125) with those for the NR group (n=48). The median observational period was 790days. The 1- and 2-year overall survival (OS) rates were 92.1 and 85.8%, respectively; the 1- and 2-year disease-free survival (DFS) rates were 78.2 and 63.0%, respectively. The AR and NR groups did not significantly differ in the OS or DFS. However, the 2-year DFS was significantly better for the AR group than the NR group among HCV patients (68.2 vs. 32.2%; P=0.004) and patients with alpha-fetoprotein (AFP) within the normal range (<20ng/ml; 76.7 vs. 60.9%; P=0.031), total bilirubin <0.8mg/dl (70.8 vs. 47.0%; P=0.034), and tumors 2-5cm in diameter (82.0 vs. 62.5%; P=0.025). If a patient is HCV-negative, has low AFP, low total bilirubin, or a tumor diameter of 2-5cm, AR is recommended.

Impact of operative and peri-operative factors on the long-term prognosis of primary liver cancer patients undergoing hepatectomy.

This study examined the impact of the operative and peri-operative factors on the long-term prognosis of patients with primary liver cancer undergoing hepatectomy. A total of 222 patients with primary liver cancer who underwent hepatectomy were followed up from January 1986 to December 2010 at Chinese PLA General Hospital. The post-operative complication rate was 14.0% for all cases, 13.7% for hepatocellular carcinoma (HCC), 10.0% for cholangiocarcinoma. The 1-, 3-, 5- and 10-year overall survival rates in patients with primary liver cancer after resection were 76.6%, 57.6%, 41.4%, and 21.0%. The survival rates were significantly higher in the HCC group than in the cholangiocarcinoma group (P=0.000), in the non-anatomical resection group than in the anatomical resection group (P=0.005), in the female group than in the male group (P=0.002), in patients receiving no blood transfusion than in those who were given intra-operative blood transfusion (P=0.000), in patients whose intra-operative blood loss was less than 400 mL than in those who intra-operatively lost more than 400 mL (P=0.000). No significant difference was found in the survival rate between the HBsAg-positive group and the HBsAg-negative group (P=0.532). Our study showed that anatomical resection, blood loss and blood transfusion were predictors of poor survival after hepatectomy for primary liver cancer patients, and concomitant hepatitis B virus infection bore no relation with the post-resection survival.

Impact of parenchymal preserving surgery on survival and recurrence after liver resection for colorectal liver metastasis.

This study aimed to investigate the impact of non-anatomical liver resection (NAR) versus anatomical resection (AR) in patients with colorectal liver metastasis (CRLM), with regard to perioperative and long-term outcomes. Analysis of prospectively collected data for patients with CRLM who underwent either AR or NAR between January 1993 and August 2011 was performed. The impact of AR and NAR on morbidity, mortality, margin positivity, redo liver resections, overall survival (OS) and disease free survival (DFS) was analysed. A total of 1574 resections for CRLM were performed. A total of 249 were redo resections and 334 patients underwent combined AR and NAR, hence, 583 were excluded. In total, 582 AR and 409 NAR were performed. The median age was 66 years (range 23.8-91.8). Median follow up was 32.2 months (interquartile range 17.5-56.9). The need for postoperative transfusion (11.6% versus 2.2%, P = <0.0001), overall complications (25% versus 10.7%, P < 0.0001) and 90-day mortality (4.9% versus 1.2%, P < 0.0001) was higher in the AR group. R0 and R1 resection rates (AR 26.2% NAR 25%, P = 0.69) and number of patients with intrahepatic recurrence was similar between the two groups (AR 17.5% NAR 22%, P = 0.08). However, the need for redo liver surgery was higher in NAR group 15.4% versus 8.7% (P < 0.001). The OS (NAR 34.1 months versus AR 31.4 months, P = 0.002) and DFS were longer in the NAR group (NAR 18.8 months versus AR 16.9 months, P = 0.031). A parenchymal preserving surgery (NAR) is associated with lower complication rates and better OS and DFS when compared with AR without compromising margin status. However, NAR increases the need for repeat liver resections.

Anatomical resection in glioblastoma: extent of resection and its impact on duration of survival

Introduction Glioblastoma is still a disease without a cure despite the use of a multimodal approach. The extent of resection has been the only modifiable factor in the different variables that affect survival. Cellular tumour infiltration beyond the visible enhancing excisable lesion remains the cornerstone for inevitable disease recurrence and progression. Patients and methods We prospectively evaluated the impact of the extent of resection beyond the visible enhancing tumour on the survival. We evaluated 59 patients with glioblastoma who were operated upon by maximum possible safe excision of the tumour and the surrounding involved gyri or lobe as long it was not considered eloquent. We followed the patients until recurrence and death. Results Fifty-nine patients, 43 men, mean age 48 years, were studied. Overall, 28.8% of the tumours were frontal, 20% were parietal, 37.2% were temporal and 14% were occipital. The median preoperative contrast-enhancing tumour volume was 42.36 ml. Twenty patients (34%) underwent anatomical excision, 21 patients (36%) underwent gross total excision, 14 patients (24%) underwent subtotal and four patients (7%) underwent surgical debulking. In all, 79.66% of the patients died. There was a statistically significant reduction in the mean survival with less aggressive resection, for which the average survival was 16.5 months for the anatomical resection group, 12.09 months for the gross total excision group, 7.34 months for the subtotal excision group and 4.67 months for the debulking group ( P = 0.002). Conclusion Total tumour resection with extra margin of tumour-infiltrated gliotic tissue, followed by adjuvant radiochemotherapy leads to longer survival than less radical excision.

Complete removal of the tumor-bearing portal territory decreases local tumor recurrence and improves disease-specific survival of patients with hepatocellular carcinoma

Anatomic resection (AR) of the tumor-bearing portal territory has been reported to be associated with a decreased recurrence of hepatocellular carcinoma (HCC). However, because of the heterogeneity of the study populations, its oncologic advantage remains controversial. The objective of the present study was to determine the clinical advantage of AR for primary HCC, based on the data from a large prospective cohort treated under a constant surgical policy. In 209 Child-Pugh class A patients with primary, solitary HCC measuring ⩽5.0cm in diameter, which was resectable either by AR or limited resection (non-AR), the overall survival (OS) and disease-free survival (DFS) were compared with patients in whom complete AR was achieved and those who eventually ended up with non-AR after adjustment for the propensity scores to select AR. Advantages of AR in disease-specific survival and local recurrence were also evaluated by competing-risks regression to clarify the true oncologic impact of AR. The AR group showed better DFS than the non-AR group (HR, 0.67; 95% CI, 0.45-0.99; p=0.046), while no significant difference was observed in OS (hazard ratio [HR], 0.82; 95% CI, 0.46-1.48; p=0.511). Competing-risks regression revealed that AR significantly decreases local recurrence (HR, 0.12; 95% CI, 0.05-0.30; p<0.001) and improves disease-specific survival (HR, 0.50; 95% CI, 0.28-0.90; p=0.020), while the other cause of death was highly influenced by patient age (>65years) (HR, 7.51; 95% CI, 2.16-26.04; p=0.002) and not associated with AR. Complete removal of tumor-bearing portal territory decreases the risk of local recurrence and death from HCC.

Anatomical versus non-anatomical resection for hepatocellular carcinoma.

The optimal surgical resection method in patients with HCC to minimize the risk of local recurrence has not yet been determined. The aim of this study was to compare the prognosis following anatomical versus non-anatomical hepatic resection for hepatocellular carcinoma (HCC). Consecutive patients with HCC without macroscopic vascular invasion, treated by curative resection between 1981 and 2012 at Osaka Medical Centre, were included in this retrospective study. The outcomes of patients selected by propensity score matching were compared. Some 1102 patients were included, 577 in the anatomical and 525 in the non-anatomical resection group. By propensity score matching, 329 patients were selected into each group. Demographic, preoperative and tumour variables were similar between the propensity score-matched groups, including tumour size, tumour multiplicity, α-fetoprotein level and 15-min indocyanine green retention rate at 15 min. The incidence of microvascular invasion was higher in the matched anatomical resection group (P = 0·048). Stratified analysis of recurrence-free and overall survival rates revealed no statistically significant differences between the two propensity score-matched groups (P = 0·704 and P = 0·381 respectively). There was also no significant difference in the early recurrence rate within 2 years after resection between these groups (P = 0·726). Subset analysis of the early recurrence-free survival rate in patients with and without microvascular invasion revealed no significant differences between the groups (P = 0·312 and P = 0·479 respectively). The resection method had no impact on the risk of HCC recurrence or survival.

Do patients with small solitary hepatocellular carcinomas without macroscopically vascular invasion require anatomic resection? Propensity score analysis

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. 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). 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). 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.

Anatomical versus Nonanatomical Resection in Patients with Hepatocellular Carcinoma Located in the Left Lateral Segment

To date, no reported studies comparing anatomical resection (AR) and nonanatomical resection (NAR) for hepatocellular carcinoma (HCC) have restricted cases by tumor location. Thus, right hepatectomy and left lateral sectionectomy are both analyzed together as AR, whereas limited resection of both peripherally and centrally located liver tumors is categorized as NAR. This categorization may result in inaccurate conclusions in the analyses comparing AR and NAR. We conducted a retrospective comparison between AR (n = 30) and NAR (n = 57) for solitary and small (5 cm or less) HCC limited to the left lateral segment (LLS) to clarify whether AR is superior to NAR for HCC in LLS. The 1-, 3-, and 5-year recurrence-free survival rates were 83.3, 71.3, and 52.9 per cent for the AR group and 82.5, 51.0, and 40.7 per cent for the NAR group, respectively (P = 0.10). The 3-, 5-, and 7-year overall survival rates were 96.0, 82.8, and 77.9 per cent for the AR group and 84.1, 77.0, and 54.2 per cent for the NAR group, respectively (P = 0.07). The postoperative complication, recurrence patterns, and secondary treatment types after recurrence were not significantly different between the two groups. The multivariate analysis including the confounders related to background liver function indicated AR to be a significant protective factor against recurrence, although AR did not influence overall survival. AR was superior to NAR in preventing recurrence without increasing postoperative risks among patients with small solitary HCC limited to the LLS, although AR could not improve overall survival.

Risk factors of post‐operative recurrence and adequate surgical approach to improve long‐term outcomes of hepatocellular carcinoma

IntroductionA high recurrence rate of hepatocellular carcinoma (HCC) remains a significant concern. The risk factors for recurrence were analysed and the optimal surgical approaches were investigated. MethodsThe subjects comprised 280 consecutive patients with primary solitary HCC measuring ≤5 cm in diameter, who underwent curative resections. Multivariate analysis was conducted to identify the risk factors for post‐operative recurrence, and the clinical significance of an anatomic resection was evaluated. ResultsMultivariate analysis identified HCV infection, a des‐gamma‐carboxyprothrombin level >100 mAU/ml, underlying cirrhosis, the presence of microvascular invasion, the presence of micrometastases and non‐anatomic resection as being significant risk factors for post‐operative recurrence. The 5‐year recurrence rate was 56.7% in the anatomic resection (AR) group and 74.7% in the non‐AR group. The 5‐year survival rate was 82.2% in the AR group and 71.9% in the non‐AR group. Local recurrence within the same segment was observed in 25% of the patients of the non‐AR group. The prognostic superiority of AR was confirmed only in patients with histopathological evidence of microvascular invasion and/or micrometastases, and in patients having a solitary HCC measuring 2 to 5 cm in diameter. ConclusionsAnatomic resection may decrease local recurrence and improve the surgical outcomes in solitary HCC measuring 2 to 5 cm in diameter.

A Comprehensive Meta-regression Analysis on Outcome of Anatomic Resection Versus Nonanatomic Resection for Hepatocellular Carcinoma

It remains unclear whether hepatectomy for hepatocellular carcinoma should be performed as an anatomic resection (AR) or a nonanatomic resection (NAR). Because no randomized controlled trials are currently available on this topic, a meta-regression analysis was performed on available observational studies to control for confounding variables. A systematic review of studies published from 1990 to 2011 in the PubMed and Embase databases was performed. Patient and disease-free survival (DFS), postoperative mortality, and morbidity were considered as outcomes. Results are expressed as relative risk (RR) or weighted mean differences with 95% of confidence interval. Eighteen observational studies involving 9,036 patients were analyzed: 4,012 were in the AR group and 5,024 in the NAR group. Meta-analysis suggested that AR provided better 5-year patient survival (RR 1.14; P=0.001) and DFS than NAR (RR 1.38; P=0.001). However, patients in the NAR group were characterized by a higher prevalence of cirrhosis (RR 1.27; P=0.010), more advanced hepatic dysfunction (RR 0.90 for Child-Pugh class A; P=0.001) and smaller tumor size (weighted mean difference 0.36cm; P<0.001) compared with patients in the AR group. Meta-regression analysis showed that the different proportion of cirrhosis in the NAR group significantly affected both 5-year patient survival (RR 1.28; P=0.016) and DFS (RR 1.74; P=0.022). Tumor size only slightly affected DFS (RR 1.72; P=0.076). Postoperative mortality and morbidity were unaffected (P>0.05 in all cases). Patient survival and DFS after AR seem to be superior to NAR because the worse liver function reserve in the NAR group significantly affects prognosis.

Recurrence after Anatomic Resection Versus Nonanatomic Resection for Hepatocellular Carcinoma: A Meta-analysis

The impact of anatomic resection (AR) as compared to non-anatomic resection (NAR) for hepatocellular carcinoma (HCC) as a factor for preventing intra-hepatic and local recurrence after the initial surgical procedure remains controversial. A systematic review and meta-analysis of nonrandomized trials comparing anatomic resection with non-anatomic resection for HCC published from 1990 to 2010 in PubMed and Medline, Cochrane Library, Embase, and Science Citation Index were therefore performed. Intra-hepatic recurrence, including early and late, and local recurrence were considered as primary outcomes. As secondary outcomes, 5 year survival and 5 year disease-free survival were considered. Pooled effects were calculated utilizing either fixed effects or random effects models. Eleven non-randomized studies including 1,576 patients were identified and analyzed, with 810 patients in the AR group and 766 in the NAR group. Patients in the AR group were characterized by lower prevalence of cirrhosis, more favorable hepatic function, and larger tumor size and higher prevalence of macrovascular invasion compared with patients in the NAR group. Anatomic resection significantly reduced the risks of local recurrence and achieved a better 5 years disease-free survival. Also, anatomic resection was marginally effective for decreasing the early intra-hepatic recurrence. However, it was not advantageous in preventing late intra-hepatic recurrence compared with non-anatomic resection. No differences were found between AR and NAR with respect to postoperative morbidity, mortality, and hospitalization. Anatomic resection can be recommended as superior to non-anatomic resection in terms of reducing the risks of local recurrence, early intra-hepatic recurrence and achieving a better 5 year disease-free survival in HCC patients.

Meta-analysis of anatomic resection versus nonanatomic resection for hepatocellular carcinoma

The choice between anatomic resection (AR) versus nonanatomic resection (NAR) for hepatocellular carcinoma (HCC) is controversial. This study is a meta-analysis of the available evidence. A systematic review and meta-analysis of trials comparing AR with NAR for HCC published from 1985 to 2009 in PubMed and Medline database, Cochrane database, Embase database, and Science Citation index were conducted. Overall survival, disease-free survival, and local recurrence rate were considered as primary outcomes. Pooled effect was calculated using either the fixed effects model or random effects model. Sixteen nonrandomized studies involving 2,917 patients were analyzed; 1,577 patients were in the AR group, and 1,340 were in the NAR group. Patients in the AR group were characterized by lower prevalence of cirrhosis and hepatitis virus infection, more favorable hepatic function, and larger tumor size compared with patients in the NAR group. AR provided a better 5-year overall survival than NAR (OR, 1.63; 95% CI, 1.15-2.32). Local recurrence (OR, 0.28; 95% CI, 0.16-0.50) and early (≤2 years) recurrence (OR, 0.55; 95 CI, 0.34-0.89) were all significantly lower in the AR group. AR improved disease-free survival significantly at 3 years (OR, 2.09; 95% CI, 1.52-2.88) and 5 years (OR, 2.24; 95% CI, 1.85-2.72). No differences were found between the two groups with respect to postoperative morbidity, mortality, and length of hospital stay. AR was superior to NAR in terms of better survival and preventing local recurrence for the treatment of HCC.

Survival After Anatomic Resection Versus Nonanatomic Resection for Hepatocellular Carcinoma: A Meta-Analysis

To compare the effect on survival of anatomic resection (AR) versus nonanatomic resection (NAR) in patients with hepatocellular carcinoma (HCC) from all published comparative studies in the literature. Databases, including Pubmed, Embase, the Cochrane Library, Ovid, and Web of Science, were searched to identify studies comparing AR with NAR for HCC. In this meta-analysis, primary end points were the overall survival and disease-free survival; the secondary end point was local recurrence rate. The meta-analysis was performed by use of RevMan 4.2. Nine comparative studies comprising 1,503 patients (833 AR and 670 NAR) were identified. In the combined results, disease-free survival was significantly higher in the AR group than in the NAR group (OR 1.78, 95% CI 1.22-2.59, P = 0.003; heterogeneity P = 0.08). Overall survival (OR 1.31, 95% CI 0.92-1.85, P = 0.13; heterogeneity P = 0.04) did not suggest any significant difference between AR and NAR. No statistically significant difference was found for local recurrence rate between the two resection methods (OR 0.55, 95% CI 0.25-1.23, P = 0.15; heterogeneity P = 0.010). Anatomic resection is associated with better disease-free survival than nonanatomic resection. Because heterogeneity was detected, caution is needed in interpretation of the results. Better designed, adequately powered studies are required to address this issue.