Anatomical versus non-anatomical resection for solitary hepatocellular carcinoma without macroscopic vascular invasion: A propensity score matching analysis

Background and Aim The superiority of anatomical resection (AR) in patients with hepatocellular carcinoma compared with non-anatomical resection (NAR) remains controversial. We aimed to investigate the prognostic outcomes of AR and NAR for solitary hepatocellular carcinoma (HCC) patients without macroscopic vascular invasion, using a propensity score matching (PSM) analysis. Methods A total of 305 consecutive HCC patients without macroscopic vascular invasion who underwent curative hepatectomy were included in our study. PSM was performed in order to eliminate possible selection bias. Results By PSM, the patients were divided into propensity-matched anatomical resection (PS-AR) (n=114) and propensity-matched non-anatomical resection (PS-NAR) (n=114) groups. The 1-year, 3-year, and 5-year overall survival rates were 90.4%, 77.7%, and 65.7% in PS-AR and 88.6%, 70.7%, and 52.2% in PS-NAR (P=0.053), respectively. The 1-year, 3-year, and 5-year recurrence-free survival (RFS) rates were 84.1%, 64.9%, and 45.1% in PS-AR and 75.4%, 48.1%, and 31.0% in PS-NAR (P=0.005), respectively. Multivariate analysis showed that ICG-R15 (P=0.022); the Barcelona clinic liver cancer staging (P=0.044) and microvascular invasion (MVI; P=0.005) were independent risk factors for the overall survival rate, while type of resection (P=0.027), surgical margin (P=0.039), and MVI (P=0.024) were independent risk factors for the RFS rate. Patients who underwent NAR were prone to early recurrence and marginal recurrence. Subgroup analysis indicated that the RFS rate was significantly better in PS-AR than that in PS-NAR (surgical margin 1cm) (P=0.025). Better RFS rate was observed in PS-AR with MVI compared with PS-NAR (P=0.016). Conclusions Anatomical resection contributed to improve the RFS rate in solitary HCC patients without macroscopic vascular invasion using PSM analysis, especially in patients with MVI.