Anatomic versus non-anatomic liver resection for hepatocellular carcinoma-A European multicentre cohort study in cirrhotic and non-cirrhotic patients

Abstract

Background: The incidence of hepatocellular carcinoma (HCC) is increasing in the western world over the past decades. As liver resection (LR) represents one of the most efficient treatment options, advantages of anatomic (ALR) versus non-anatomic liver resection (NALR) show a lack of consistent evidence. Therefore, the aim of this study was to investigate complications and survival rates after both resection types.

Methods: This is a multicentre cohort study using retrospectively and prospectively collected data. We included all patients undergoing LR for HCC between 2009 and 2020 from three specialised centres in Switzerland and Germany. Complication and survival rates after ALR versus NALR were analysed using uni- and multivariate Cox regression models.

Results: Two hundred and ninety-eight patients were included. Median follow-up time was 52.76 months. 164/298 patients (55%) underwent ALR. Significantly more patients with cirrhosis received NALR (n = 94/134; p < 0.001). Complications according to the Clavien Dindo classification were significantly more frequent in the NALR group (p < 0.001). Liver failure occurred in 13% after ALR versus 8% after NALR (p < 0.215). Uni- and multivariate cox regression models showed no significant differences between the groups for recurrence free survival (RFS) and overall survival (OS). Furthermore, cirrhosis had no significant impact on OS and RFS.

Conclusion: No significant differences on RFS and OS rates could be observed. Post-operative complications were significantly less frequent in the ALR group while liver specific complications were comparable between both groups. Subgroup analysis showed no significant influence of cirrhosis on the post-operative outcome of these patients.

Keywords: anatomic liver resection; cirrhosis; hepatocellular carcinoma; liver resection; non-anatomic liver resection; surgical oncology.

FIGURE 1

Overall survival curves and recurrence free survival curves. (A) Recurrence free survival in cirrhotic and non‐cirrhotic patients after NALR. (B) Recurrence free survival in cirrhotic and non‐cirrhotic patients after ALR. (C) Recurrence free survival after ALR and NALR. (D) Overall survival in cirrhotic and non‐cirrhotic patients after NALR. (E) Overall survival in cirrhotic and non‐cirrhotic patients after ALR. (F) Overall survival after ALR and NALR. ALR, anatomic liver resection; NALR, non‐anatomic liver resection.