Revisiting the role of nonanatomic resection of small (< or = 4 cm) and single hepatocellular carcinoma in patients with well-preserved liver function

Abstract

Background: Anatomic resection of the liver in patients with hepatocellular carcinoma (HCC) is generally recommended. Several previous reports have described the potential superiority of anatomic resection. However, no clear evidence of long-term survival or other advantages compared with those achieved with limited resection exist. We evaluated the oncologic outcomes of nonanatomic resection performed as a primary treatment for small (<or=4 cm) and single HCC in patients with well-preserved liver function (Child-Pugh class A).

Materials and methods: From March 1998 to January 2005, 353 consecutive patients underwent resection of HCC. Among them, 167 patients with single and small (<or=4 cm) HCC and well-preserved liver function (Child-Pugh class A) were selected. Twenty-one patients (12.6%) underwent nonanatomic resection (Group NA) and 146 (82.4%) underwent anatomic resection (Group A). Patient factors, tumor factors, surgery factors, disease-free survival, and recurrence patterns were compared between the two groups.

Results: There were no significantly different preoperative clinical characteristics between the two groups (Group NA versus Group A). Only the resection margin width (0.8 +/- 0.6 cm versus 2.0 +/- 1.4 cm, P < 0.001) and operative time (211.9 +/- 72.9 min versus 251 +/- 80.0 min, P = 0.036) were significantly different between the two groups. There was no difference in disease-free survival between the two groups, and platelet counts of less than 100,000/microL (P = 0.038), satellite nodules (P = 0.0164), and microscopic portal vein invasion (P < 0.001) were significant prognostic factors predicting disease-free survival in univariate analysis. Subsequent Cox-proportional hazards models revealed that both microscopic portal vein invasion (Exp {beta} = 3.281, P < 0.001) and platelet counts of less than 100,000/microL (Exp {beta} = 1.913, P = 0.012) adversely affected disease-free survival. Nonanatomic resection did not have adverse effects on early recurrence compared to anatomic resection (P = 0.805).

Conclusion: Our study showed that nonanatomic resection has no adverse effects on the oncologic outcomes of single and small (<or=4 cm) HCC in patients with well-preserved liver function (Child-Pugh class A).