Efficacy of anatomic resection vs nonanatomic resection for small nodular hepatocellular carcinoma based on gross classification |
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Authors: | Ueno Shinichi Kubo Fumitake Sakoda Masahiko Hiwatashi Kiyokazu Tateno Taro Mataki Yuko Maemura Kosei Shinchi Hiroyuki Natsugoe Shoji Aikou Takashi |
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Institution: | (1) Department of Surgical Oncology and Digestive Surgery, Field of Oncology, Course of Advanced Therapeutics, Kagoshima University Graduate School of Medicine and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima 890-8520, Japan |
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Abstract: | Background/Purpose It has been reported that anatomic resection may be preferable to nonanatomic resection for small hepatocellular carcinomas
(HCCs), by reducing socalled “micrometastases” (portal venous tumor extension and intrahepatic metastases). Nonanatomic resection
or ablation has also been used as therapy for small HCCs. We studied the effectiveness of anatomic resection for small nodular
HCCs, especially from the viewpoints of tumor size and gross classification.
Methods A retrospective cohort study was performed in 116 consecutive patients who underwent curative hepatic resection for HCCs 3
cm or smaller and with three or fewer nodules. The outcome of anatomic resection (including segmentectomy, sectoriectomy,
and hemihepatectomy) was compared to that of nonanatomic partial hepatectomy.
Results The group that underwent anatomic resection (n = 52) had relatively better overall survival and significantly better recurrence-free survival than those with nonanatomic
resection (n = 64). On Cox multivariate analysis, however, liver function was more closely associated with survival. The effect of anatomic
resection was more prominent in the subgroup with the nonboundary type nodules (single nodular type with extranodular growth,
confluent multinodular type, and invasive type) than in the subgroup with the boundary type (vaguely nodular and single nodular
type). Micrometastases in the nonboundary type were found further from the main tumor (9.5 ± 6.2 mm) than those in the boundary
type (within 3.1 +-1.4 mm).
Conclusions In patients with HCC nodules equal to or less than 3 cm and with the nonboundary type, anatomic resection should be employed
to the extent that liver function allows, because this procedure would be more favorable than nonanatomic resection in eradicating
micrometastases that have extended away from the tumor’s margin. |
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Keywords: | Hepatocellular carcinoma Anatomic resection Micrometastasis |
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