Revisiting the Role of Nonanatomic Resection of Small (≤4 cm) and Single Hepatocellular Carcinoma in Patients With Well-Preserved Liver Function

Chang Moo Kang, Gi Hong Choi, Dong Hyun Kim, Sae-Byeol Choi, Kyung Sik Kim, Jin Sub Choi, Woo Jung Lee

Research output: Contribution to journalArticle

39 Citations (Scopus)

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 (≤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 (≤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/μL (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 {β} = 3.281, P < 0.001) and platelet counts of less than 100,000/μL (Exp {β} = 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 (≤4 cm) HCC in patients with well-preserved liver function (Child-Pugh class A).

Original languageEnglish
Pages (from-to)81-89
Number of pages9
JournalJournal of Surgical Research
Volume160
Issue number1
DOIs
Publication statusPublished - 2010 May 1
Externally publishedYes

Fingerprint

Hepatocellular Carcinoma
Liver
Disease-Free Survival
Portal Vein
Platelet Count
Recurrence
Operative Time
Proportional Hazards Models
Survival
Neoplasms

Keywords

  • anatomic
  • hepatocellular carcinoma
  • nonanatomic
  • resection

ASJC Scopus subject areas

  • Surgery

Cite this

Revisiting the Role of Nonanatomic Resection of Small (≤4 cm) and Single Hepatocellular Carcinoma in Patients With Well-Preserved Liver Function. / Kang, Chang Moo; Choi, Gi Hong; Kim, Dong Hyun; Choi, Sae-Byeol; Kim, Kyung Sik; Choi, Jin Sub; Lee, Woo Jung.

In: Journal of Surgical Research, Vol. 160, No. 1, 01.05.2010, p. 81-89.

Research output: Contribution to journalArticle

Kang, Chang Moo ; Choi, Gi Hong ; Kim, Dong Hyun ; Choi, Sae-Byeol ; Kim, Kyung Sik ; Choi, Jin Sub ; Lee, Woo Jung. / Revisiting the Role of Nonanatomic Resection of Small (≤4 cm) and Single Hepatocellular Carcinoma in Patients With Well-Preserved Liver Function. In: Journal of Surgical Research. 2010 ; Vol. 160, No. 1. pp. 81-89.
@article{5720625ffa4f499ba71f74b953badbc5,
title = "Revisiting the Role of Nonanatomic Resection of Small (≤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 (≤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 (≤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/μL (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 {β} = 3.281, P < 0.001) and platelet counts of less than 100,000/μL (Exp {β} = 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 (≤4 cm) HCC in patients with well-preserved liver function (Child-Pugh class A).",
keywords = "anatomic, hepatocellular carcinoma, nonanatomic, resection",
author = "Kang, {Chang Moo} and Choi, {Gi Hong} and Kim, {Dong Hyun} and Sae-Byeol Choi and Kim, {Kyung Sik} and Choi, {Jin Sub} and Lee, {Woo Jung}",
year = "2010",
month = "5",
day = "1",
doi = "10.1016/j.jss.2009.01.021",
language = "English",
volume = "160",
pages = "81--89",
journal = "Journal of Surgical Research",
issn = "0022-4804",
publisher = "Academic Press Inc.",
number = "1",

}

TY - JOUR

T1 - Revisiting the Role of Nonanatomic Resection of Small (≤4 cm) and Single Hepatocellular Carcinoma in Patients With Well-Preserved Liver Function

AU - Kang, Chang Moo

AU - Choi, Gi Hong

AU - Kim, Dong Hyun

AU - Choi, Sae-Byeol

AU - Kim, Kyung Sik

AU - Choi, Jin Sub

AU - Lee, Woo Jung

PY - 2010/5/1

Y1 - 2010/5/1

N2 - 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 (≤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 (≤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/μL (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 {β} = 3.281, P < 0.001) and platelet counts of less than 100,000/μL (Exp {β} = 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 (≤4 cm) HCC in patients with well-preserved liver function (Child-Pugh class A).

AB - 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 (≤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 (≤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/μL (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 {β} = 3.281, P < 0.001) and platelet counts of less than 100,000/μL (Exp {β} = 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 (≤4 cm) HCC in patients with well-preserved liver function (Child-Pugh class A).

KW - anatomic

KW - hepatocellular carcinoma

KW - nonanatomic

KW - resection

UR - http://www.scopus.com/inward/record.url?scp=77950299491&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=77950299491&partnerID=8YFLogxK

U2 - 10.1016/j.jss.2009.01.021

DO - 10.1016/j.jss.2009.01.021

M3 - Article

VL - 160

SP - 81

EP - 89

JO - Journal of Surgical Research

JF - Journal of Surgical Research

SN - 0022-4804

IS - 1

ER -