Anatomical Hepatectomy For Hepatocellular Carcinoma

Objective: To evaluate the safety and clinical efficacy of anatomical liver resection versus nonanatomical resection in the treatment of hepatocellular carcinoma(HCC). In addition, to explore the influencing factors of the tumor recurrence.Methods: A retrospective study was used, collecting 116 cases with the liver resection of HCC from January 2002 to March 2004. Among them, the anatomical group included 53 cases , while the nonanatomical group of 63 cases. Comparing the the clinical characteristics,intraoperative and postoperative variables, and evaluate the outcome of both hepatectomy procedures by the log-rank test and the COX regression model.Results:1. Clinical features:two groups of age, gender, HBV infection (HBcAg positive), liver function , cirrhosis , preoperative ALT/ AST were not significantly difference. Among them, the overall age of onset 23-82 years old, median age 52 years old; male incidence rate than women (3.64:1); HBV infection rate is as high as 91.38%.2. Cancer characteristics:tumor characteristics of the two groups had no significant statistical difference. The majority of tumors have a complete capsule and almost in one or two segments. Portal vein invasion is common , accounting for 23.28% of the total number. Pathological grade are mainly moderate differentiation.3. Intraoperative and postoperative situation:The utilization of Intraoperative ultrasonography (IOUS) in anatomical group (98.11%) is higher than nonanatomical group (53.97%). Anatomical resection group has greater tumor-free margin (P=0.036). Although the operating duration of the anatomical group was significantly higher than that of nonanatomical group(P=0.000), the blood loss in the anatomical group was less(P=0.047),The remaining surgical parameters,postoperative duration in hospital and postoperative comparison of the two groups have no difference.4. Complications: All patients have no in-hospital deaths and fatal complications. However, a total of 21 cases (18.10%) appeared operation-related complications, 7 cases(6.03%) in anatomic group, other than 14 cases (12.06%) in nonanatomical resection group, there is no statistical difference (P=0.311). However, in the postoperative bleeding and biliary fistula, the anatomical resection group was superior to nonanatomical resection group.5. Follow-up results and survival analysis: All patients were followed up, with time of 3-86 months. The 1-,3-,5-year disease-free survival rates in anatomical group were 77.36%, 49.01%, 35.85%, and 69.84%, 36.51%, 22.22% in nonanatomical group , respectively. The survival by single-factor analysis showed that, in addition to surgery management, there were tumor size, portal vein invasion, operative margin, pathological grade and satellite nodules with significant correlation of disease-free survival(DFS) (P <0.05).The COX regression analysis showed that surgical management, operative margin and portal vein invasion are independent risk factors of recurrence.Conclusion: The anatomical liver resection is with relatively complex technology. The safety of anatomical liver resection is superior to nonanatomical liver resection and minimize recurrent HCC after resection. The anatomical liver resection yields more favorable results rather than nonanatomical resection.