The Clinical Study Of Anatomic Resection For Hepatocellular Carcinoma

Part oneDifferentiating the impact of anatomic and non-anatomic liver resectionon early mortality in patients with Hepatocellular CarcinomaObjective：To compare the impact of the type of resection (anatomicversus non-anatomic) on early mortality in patients with HCC and to explorefactors related to early mortality in patients after resection of tumor.Methods：Retrospective analysis fifty-two patients with similarclinico-pathologic data who underwent curative liver resection for HCC, 25patients underwent anatomic resection of at least one liver segment and 27patients underwent non-anatomic resection. We record the age, gender,HbsAg, preoperative serum albumin, AFP, postoperative pathologic diagnosis,TNM stage, tumor size, portal vein thrombosis, duration of hospital stay andfollow-up of the patients in the two groups.Results：The one year mortality is 20.0% in anatomic resection groupand 25.9% in non-anatomic group. No significant difference was detected inearly mortality and complications between the anatomic and the non-anatomicgroups. The blood loss in operating of anatomic group are less thannon-anatomic group (P=0.006). Univariate analysis suggested that tumor sizeand portal vein thrombosis related to survival time. Multivariate analysissuggested that factor contributing to early mortality was presence of portalvein thrombosis (P=0.019).Conclusion：There is no significant difference in early mortality between Anatomic and non-anatomic liver resection. The presence of portal veinthrombosis can become an independent factor to predict early mortality.Part twoAnatomic resection for hepatocellular carcinoma (≤5cm): a Meta analysisObjective：To evaluate the impact of anatomic and non-anatomic liverresection on prognosis of patients with small hepatocellular carcinoma (HCC)using a meta-analysis.Methods：Literature on anatomic versus non-anatomic liver resection forthe treatment of small HCC（≤5cm）was retrieved according to the Criteriaof inclusion and exclusion. A meta-analysis was conducted to estimate theoutcome of anatomic resection and nonanatomic resection.Results：Four non-randomized controlled trials were included in thisanalysis. These studies included a total of 776 patients: 484 treated withanatomic liver resection and 292 treated with non-anatomic resection. The ageranged from 53.4 to 63.0 years. Male: female ratio was 3.56:1. 87.1% patientswere Child-Pugh class A. Most patients (94.5%) had a single tumor. Therewas no significant difference between the two groups when comparing the 1,3and 5-year disease-free survival rate and overall survival rate. We use thesensitivity analysis which found anatomic resection could extend the 3-yeardisease-free survival rate when compared with non-anatomic resection (Oddsratios (OR)=0.72，95% Confidence interval (CI)：0.52～0.99，P=0.04).Conclusions：Anatomic liver resection can extend the 3-yeardisease-free survival rate of patients with small hepatocellular carcinomawhen compared with non-anatomic hepatectomy, but failed to further elevate long-term disease free survival and overall survival. Further randomizedcontrolled trials are needed to define the exact value of anatomic resectionand non-anatomic resection for small HCC.