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. 2018 Nov;22(4):326-334.
doi: 10.14701/ahbps.2018.22.4.326. Epub 2018 Nov 27.

Is the anatomical resection necessary for single hepatocellular carcinoma smaller than 3 cm?: single-center experience of liver resection for a small HCC

Sungwook Shin  1 , Tae-Seok Kim  1 , Jeong Woo Lee  1 , Keun Soo Ahn  1 , Yong Hoon Kim  1 , Koo Jeong Kang  1
Affiliations

Is the anatomical resection necessary for single hepatocellular carcinoma smaller than 3 cm?: single-center experience of liver resection for a small HCC

Sungwook Shin et al. Ann Hepatobiliary Pancreat Surg. 2018 Nov.

Abstract

Backgrounds/aims: The superiority of anatomical resection (AR) for a small HCC remains controversial. In this study, we investigated the clinical outcomes after AR and non-anatomical liver resection (NAR) for single HCC smaller than 3 cm and the risk factors for HCC recurrence.

Methods: A total of 116 consecutive patients who underwent liver resection for single HCC (<3 cm) between Jan 2006 and Dec 2015 were included in this study. The medical records of these patients were reviewed and analyzed retrospectively.

Results: There was no significant difference in tumor recurrence and survival between AR and NAR group. Multivariate analysis showed that hepatitis B (p=0.035, HR=8.72), presence of satellite nodule (p=0.029, HR=3.97) and microvascular invasion (MVI) (p=0.039, HR=2.79) were independent risk factors for early recurrence within 1 year. The overall recurrence was independently related to the presence of satellite nodule (p=0.001, HR=4.98) and background liver cirrhosis (p=0.032, HR=1.96). In patients with MVI, HCC recurrence was significantly more frequent in width of safety margin <1 cm group than ≥1 cm group (p=0.049).

Conclusions: The outcomes of NAR are comparable with those of AR in single HCC smaller than 3 cm. The presence of satellite nodule, MVI and hepatitis B are the independent risk factors for early recurrence, however overall recurrence is correlated with background liver cirrhosis and the presence of satellite nodule rather than pathobiologic factors in single HCC smaller than 3 cm. Hepatic resection with sufficient margin (≥1 cm) is recommended for decreasing risk of recurrence in patients with suspected MVI.

Keywords: Anatomical resection; Hepatic resection; Hepatocellular carcinoma; Non-anatomical resection.

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Figures

Fig. 1
Fig. 1. Overall survival (A) and recurrence-free survival (B) rates after hepatic resection for single HCC smaller than 3 cm (n=113).
Fig. 2
Fig. 2. Overall survival (A) and recurrence-free survival (B) rates according to the extent of surgery (AR/NAR) in patients with single HCC smaller than 3 cm.
Fig. 3
Fig. 3. Recurrence-free survival rates according to the width of safety margin (A) and presence of microvascular invasion (B). (C) The different recurrence-free survival according to the width of safety margin in MVI (−) and MVI (+) group.
See this image and copyright information in PMC

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