Anatomic Versus Non-Anatomic Hepatic Resection for Patients with Stage I and II Hepatocellular Carcinoma

Aim: This retrospective study compares the outcome of patients undergoing anatomical versus non-anatomical hepatic resection for stage I and II HCC. Patients and methods: This retrospective study included 25 patients with T I and II HCC managed by hepatic resection. Patients were divided into two groups. Group A: Anatomic resection (n: 14) was treated by the complete removal of at least one liver segment. Group B: Non-anatomic resection (n:11) was treated by the resection of the tumor with a margin of at least 1 cm without regard to segmental, sectional or lobar anatomy. The two patients groups were subjected to a close follow-up of 23.9 ± 8.22 months. Results: No difference was detected between the 2 groups in clinical and demographic characteristics. Mean operative time was 3.11 ± 1.00 versus 3.18 ± 0.717 hours (p: 0.84). Mean operative blood loss was 1050± 626 versus 1045± 460 (p: 0.27). Mean tumor size was 4.00± 0.855 cm and 3.73 ± 1.06 cm (p: 0.48). Tumors were capsulated in 10 (71.4%) group A and 8 (72.7%) Group B patients. Resection margin was infiltrated in 2 (14.3%) and 1 (9.1 %) patients. Microscopic invasion was found in 5 (35.7%) and 4 (36.4%) patients. Mean period of hospital stay was 8.29 ± 7.04 and 6.45 ± 3.05 days (p: 0.43). There were early complications in 8 patients (57.1%) from group A and 3 patients (21.3%) from Group B (p: 0.15). Severe deterioration in liver functions and eventually death occurred in 1 patient and postoperative hemorrhagic shock and ARDS leading to death in 1 patient. During early follow up, 8 patients (57.1%) from group A and 8 patients (72.7%) from Group B developed recurrence; 3 patients (21.3%) and 4 patients (36.4%) within 1 year after operation. Mean time of recurrence was 14.0 ± 6.14 versus 12.1 ± 8.11 months (p: 0.61). Using the univariate analysis method, there was no difference between the 2 groups in recurrence (p: 0.44). Six patients (42.8%) from group A and 3 patients (27.3%) from group B died during the follow up period. Mean diseasefree survival was 15.071 ± 2.298 versus 15.182 ± 2.652 months (p: 0.98). Cumulative overall survival proportion was 58.2% versus 72.7%. Mean overall survival was 18.214 ± 2.361 months versus 21.909±1.156 (p: 0.21). Results of univariate analysis showed no statistically significant factors to differentiate between both groups. Conclusion: We conducted this retrospective analysis for patients with HCC undergoing hepatic resection, and examined the background and clinical outcomes. The local recurrence rate was similar after anatomical and non-anatomical resection. Disease-free and overall survivals after anatomical and non-anatomical resection were not significantly different. Hepatic resection in cirrhotic patients should be done with good expertise and follows strict selection criteria. Non-Anatomical resection may be more preferable in cirrhotic patients with small HCC to leave adequate functioning liver parenchyma and to avoid increased postoperative morbidity