Significance of anatomic resection for early and advanced hepatocellular carcinoma

Although it remains controversial whether local ablation or surgery is better for early-stage hepatocellular carcinoma (HCC), surgical resection is the first choice for advanced HCC. Anatomic hepatic resection is the preferred procedure to improve prognosis, but to date, its superiority has been demonstrated only for early-stage HCC. This study aimed to evaluate the effect of anatomic resection in advanced HCC in which surgical resection is the first choice.

The prognosis of 210 patients who underwent curative resection for primary HCC was analyzed. Sixty-three patients with no more than three tumors, none of which were larger than 3 cm in diameter, and with no macroscopic vascular invasion were classified as early HCC (group E); the other 147 patients were classified as advanced HCC (group A).

The 5-year survival rate was better in group E (73% vs. 55%, P < 0.01), but the 5-year recurrence-free survival rate was equivalent between the two groups (E vs. A; 30% vs. 32%, P = 0.19). Multivariate analysis showed that independent predictors of good survival in group E were indocyanine green retention rate at 15 min ≤20% [hazard ratio (HR) = 0.30; 95% confidential interval (CI),  0.10-0.88) and tumor differentiation grade of well or moderate or complete necrosis (HR = 0.14; 95% CI,  0.03-0.95), while predictors in group A were anatomic resection (HR = 0.48; 95% CI,  02.27-0.85) and no macroscopic vascular invasion (HR = 0.35; 95% CI,  0.17-0.72).

For advanced HCC, anatomic resection should be performed to improve patient prognosis.