Outcomes Of Non-anatomic Liver Resection For Hepatocellular Carcinoma In Patients With Liver Cirrhosis And Analysis Of Prognostic Factors

BACKGROUND AND OBJECTIVE: It has been overwhelmingly reported that anatomic liver resection achieves the best clinical outcomes for treatment of hepatocellular carcinomas (HCC). As most of HCC patients in the east countries are associated with varied degrees of liver cirrhosis, however, the application of anatomic resection is therefore largely limited, especially in those with severe liver cirrhosis. However, The clinical outcomes of non-anatomic resection in patients with varied degree of cirrhosis are still lacking.METHODS: Between January 2003 and December 2006, 77 consecutive HCC patients with mild, moderate or severe liver cirrhosis underwent non-anatomic liver resection in Tongji hospital. The clinicopathological and surgical characteristics, survivals of these patients with varied degree of cirrhosis were retrospectively evaluated and compared, and the prognostic factors were analyzed.RESULTS: Cumulative 1, 2, 3-year overall survival rates of this cohort of patients were 78%,68%, 56%, and disease-free survival rates were 66%,58%, 55% respectively. The perioperative motility rate was zero, and mobility rate was 27%. The 1, 2, 3-year overall survival were 87.5%, 79.2% and 75% in the patients with tumor smaller than 5 cm, and 75.5%, 62.3% and 47.2% in the patients with tumor equal to or larger than 5 cm. There was a significant difference between the two groups (P=0.002). The 1, 2, 3-year overall survival were 85.7%, 77.1% and 74.3% in the patients with mild liver cirrhosis, and 60.0%, 53.3% and 26.7% in the patients with severe cirrhosis. There was a significant difference between the two groups (P=0.003). Multivariate and univariate analysis revealed that statistically significant independent factors for overall survival were liver cirrhosis, tumor diameter >=5cm and vascular invasion.CONCLUSIONS: Non-anatomic liver resection for HCCs in patients with liver cirrhosis could yield comparable outcomes with anatomic resection, especially in those with tumors smaller than 5 cm. Non-anatomic resection preserves more liver parenchyma and therefore reduces postoperative complications. Non-anatomical resection is a safe and effective surgical strategy in treatment of HCC patients with liver cirrhosis.