Comparison of anatomic and non-anatomic resections for very early-stage hepatocellular carcinoma: The importance of surgical resection margin width in non-anatomic resection

Background: The superiority of anatomic resection (AR) over non-anatomic resection (NAR) for very early-stage hepatocellular carcinoma (HCC) has remained a topic of debate. Thus, this study aimed to compare the prognosis after AR and NAR for single HCC less than 2 cm in diameter. Methods: Consecutive patients with single HCC of diameter less than 2 cm who underwent curative hepatectomy between 1997 and 2017 were included in this retrospective study. Results: In total, 159 patients were included in this study. Of these, 52 patients underwent AR (AR group) and 107 patients underwent NAR (NAR group). No significant differences were noted in recurrence-free survival (RFS) and overall survival (OS) between the AR and NAR groups (P = 0.236 and P = 0.363, respectively). Multivariate analysis revealed that low preoperative platelet count and presence of satellite nodules were independent prognostic factors of RFS and OS. Wide surgical resection margin did not affect RFS (P = 0.692) in the AR group; however, in the NAR group, RFS was found to be higher with surgical resection margin widths >= 1 cm than with surgical resection margin widths <1 cm (P = 0.038). Conclusions: Prognosis was comparable between the NAR and AR groups for very early-stage HCC with well-preserved liver function. For better oncologic outcomes, surgeons should endeavor in keeping the surgical resection margin widths during NAR >= 1 cm.

Automated summary

The study compared the prognosis after anatomic resection (AR) and non-anatomic resection (NAR) for single hepatocellular carcinoma (HCC) less than 2 cm in diameter and found comparable outcomes between the two groups. Wide surgical resection margin was found to impact recurrence-free survival in the NAR group, suggesting the importance of maintaining a margin width of >= 1 cm during NAR for better oncologic outcomes. Independent prognostic factors for prognosis included low preoperative platelet count and presence of satellite nodules.