Ann Hepatobiliary Pancreat Surg.  2018 Nov;22(4):326-334. 10.14701/ahbps.2018.22.4.326.

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

• Shin S
• Kim TS
• Lee JW
• Ahn KS
• Kim YH
• Kang KJ

• KMID: 2427363
• DOI: http://doi.org/10.14701/ahbps.2018.22.4.326

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.

Keyword

Hepatocellular carcinoma; Hepatic resection; Anatomical resection; Non-anatomical resection

MeSH Terms

Carcinoma, Hepatocellular*
Hepatitis B
Humans
Liver Cirrhosis
Liver*
Medical Records
Multivariate Analysis
Recurrence
Retrospective Studies
Risk Factors

Figure

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  Fig. 1 Overall survival (A) and recurrence-free survival (B) rates after hepatic resection for single HCC smaller than 3 cm (n=113).

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  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.

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  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.

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