Skip to main content
SpringerLink
Log in

Analysis of Recurrence Patterns After Anatomical or Non-anatomical Resection for Hepatocellular Carcinoma

  • Hepatobiliary Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Recurrence patterns after hepatic resection has been poorly understood in view of tumor blood flow drainage (TBFD) area. Our goal was to clarify the recurrence patterns after anatomical versus nonanatomical hepatic resection for hepatocellular carcinoma (HCC).

Methods

A total of 424 consecutive patients with HCC, who were treated by curative resection (R0) at our hospital from 2001 to 2012, were evaluated. Among these, we compared the outcomes of the anatomical resection group (AR group, n = 243) and the nonanatomical resection group (NR group, n = 181). We performed an analysis of the recurrence patterns of HCC based on the preoperative CT during hepatic arteriography in these 424 patients.

Results

Preoperative liver function was better in the AR group than the NR group (P < 0.001), and tumor size was larger in the AR group than the NR group (P < 0.001). HCC recurrence was recorded in 145 patients (59.7 %) of the AR group and 102 patients (56.4 %) of the NR group with no significant differences between the two groups (P = 0.590). The incidences of extrahepatic and intrahepatic recurrence (solitary/multiple) were similar between the two groups. In addition, the rate of recurrences by local dissemination, either recurrences in the same subsegment in the NR group or recurrences in the TBFD area in the AR group, was sufficiently low (1.4 %) as to be considered negligible.

Conclusions

The incidence and patterns of HCC recurrence were similar between the anatomical and nonanatomical resection. Recurrence by local dissemination may be considered to be negligible in both surgical methods.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

Abbreviations

AFP:

α-fetoprotein

AFP-L3:

LCA-reactive α-fetoprotein isoform

ALT:

Alanine aminotransferase

CTAP:

CT during arterial portography

CTHA:

CT during hepatic arteriography

DCP:

Des-γ-carboxy prothrombin

HCC:

Hepatocellular carcinoma

ICG15R:

15-min retention rate for indocyanine green

PT:

Prothrombin time

TBF:

Tumor blood flow

References

  1. Bosch FX, Ribes J, Diaz M, Cleries R. Primary liver cancer: worldwide incidence and trends. Gastroenterology. 2004;127:S5–16.

    Article  PubMed  Google Scholar 

  2. Tiong L, Maddern GJ. Systematic review and meta-analysis of survival and disease recurrence after radiofrequency ablation for hepatocellular carcinoma. Br J Surg. 2011;98:1210–24.

    Article  CAS  PubMed  Google Scholar 

  3. Sakon M, Nagano H, Nakamori S, et al. Intrahepatic recurrences of hepatocellular carcinoma after hepatectomy: analysis based on tumor hemodynamics. Arch Surg. 2002;137:94–9.

    Article  PubMed  Google Scholar 

  4. Belghiti J, Panis Y, Farges O, et al. Intrahepatic recurrence after resection of hepatocellular carcinoma complicating cirrhosis. Ann Surg. 1991;214:114–7.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  5. Nagasue N, Uchida M, Makino Y, et al. Incidence and factors associated with intrahepatic recurrence following resection of hepatocellular carcinoma. Gastroenterology. 1993;105:488–94.

    Article  CAS  PubMed  Google Scholar 

  6. Chen MF, Hwang TL, Jeng LB, et al. Postoperative recurrence of hepatocellular carcinoma. Two hundred five consecutive patients who underwent hepatic resection in 15 years. Arch Surg. 1994;129:738–42.

    Article  CAS  PubMed  Google Scholar 

  7. Duffy JP, Hiatt JR, Busuttil RW. Surgical resection of hepatocellular carcinoma. Cancer J. 2008;14:100–10.

    Article  PubMed  Google Scholar 

  8. Poon RT, Fan ST, Lo CM, et al. Long-term survival and pattern of recurrence after resection of small hepatocellular carcinoma in patients with preserved liver function: implications for a strategy of salvage transplantation. Ann Surg. 2002;235:373–82.

    Article  PubMed Central  PubMed  Google Scholar 

  9. Ikai I, Arii S, Okazaki M, et al. Report of the 17th nationwide follow-up survey of primary liver cancer in Japan. Hepatol Res. 2007;37:676–91.

    Article  PubMed  Google Scholar 

  10. Wu CC, Cheng SB, Ho WM, et al. Liver resection for hepatocellular carcinoma in patients with cirrhosis. Br J Surg. 2005; 92:348–355.

    Article  PubMed  Google Scholar 

  11. Ercolani G, Grazi GL, Ravaioli M, et al. Liver resection for hepatocellular carcinoma on cirrhosis: univariate and multivariate analysis of risk factors for intrahepatic recurrence. Ann Surg. 2003;237:536–43.

    PubMed Central  PubMed  Google Scholar 

  12. Makuuchi M, Hasegawa H, Yamazaki S. Ultrasonically guided subsegmentectomy. Surg Gynecol Obstet. 1985;161:346–50.

    CAS  PubMed  Google Scholar 

  13. Imamura H, Matsuyama Y, Miyagawa Y, et al. Prognostic significance of anatomical resection and des-gamma-carboxy prothrombin in patients with hepatocellular carcinoma. Br J Surg. 1999;86:1032–8.

    Article  CAS  PubMed  Google Scholar 

  14. Yamamoto M, Takasaki K, Ohtsubo T, et al. Effectiveness of systematized hepatectomy with Glisson’s pedicle transection at the hepatic hilus for small nodular hepatocellular carcinoma: retrospective analysis. Surgery. 2001;130:443–8.

    Article  CAS  PubMed  Google Scholar 

  15. Hasegawa K, Kokudo N, Imamura H, et al. Prognostic impact of anatomic resection for hepatocellular carcinoma. Ann Surg. 2005;242:252–9.

    Article  PubMed Central  PubMed  Google Scholar 

  16. Eguchi S, Kanematsu T, Arii S, et al. Comparison of the outcomes between an anatomical subsegmentectomy and a non-anatomical minor hepatectomy for single hepatocellular carcinomas based on a Japanese nationwide survey. Surgery. 2008;143:469–75.

    Article  PubMed  Google Scholar 

  17. Sasaki K, Matsuda M, Ohkura Y, et al. Anatomical versus nonanatomical resection in patients with hepatocellular carcinoma located in the left lateral segment. Am Surg. 2013;79:1163–70.

    PubMed  Google Scholar 

  18. Ochiai T, Ikoma H, Yamamoto Y, et al. Anatomical hepatectomy for hepatocellular carcinoma in patients with preserved liver function. Anticancer Res. 2013;33:1689–95.

    PubMed  Google Scholar 

  19. Wakai T, Shirai Y, Sakata J, et al. Anatomic resection independently improves long-term survival in patients with T1–T2 hepatocellular carcinoma. Ann Surg Oncol. 2007;14:1356–65.

    Article  PubMed  Google Scholar 

  20. Ueno S, Kubo F, Sakoda M, et al. Efficacy of anatomic resection vs nonanatomic resection for small nodular hepatocellular carcinoma based on gross classification. J Hepatobiliary Pancreat Surg. 2008;15:493–500.

    Article  PubMed  Google Scholar 

  21. Kaibori M, Matsui Y, Hijikawa T, et al. Comparison of limited and anatomic hepatic resection for hepatocellular carcinoma with hepatitis C. Surgery. 2006;139:385–94.

    Article  PubMed  Google Scholar 

  22. Tanaka K, Shimada H, Matsumoto C, et al. Anatomic versus limited nonanatomic resection for solitary hepatocellular carcinoma. Surgery. 2008;143:607–15.

    Article  PubMed  Google Scholar 

  23. Kang CM, Choi GH, Kim DH, et al. Revisiting the role of nonanatomic resection of small (<or = 4 cm) and single hepatocellular carcinoma in patients with well-preserved liver function. J Surg Res. 2010;160:81–9.

    Article  PubMed  Google Scholar 

  24. Tomimaru Y, Eguchi H, Marubashi S, et al. Equivalent outcomes after anatomical and non-anatomical resection of small hepatocellular carcinoma in patients with preserved liver function. Dig Dis Sci. 2012;57:1942–8.

    Article  PubMed  Google Scholar 

  25. Sakon M, Nagano H, Shimizu J, et al. Hepatic resection of hepatocellular carcinomas based on tumor hemodynamics. J Surg Oncol. 2000;73:179–81.

    Article  CAS  PubMed  Google Scholar 

  26. Sakon M, Ogawa H, Fujita M, Nagano H. Hepatic resection for hepatocellular carcinoma based on tumor hemodynamics. Hepatol Res. 2013;43:155–64.

    Article  PubMed  Google Scholar 

  27. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240:205–13.

    Article  PubMed Central  PubMed  Google Scholar 

  28. Clavien PA, Barkun J, de Oliveira ML, et al. The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg. 2009;250:187–96.

    Article  PubMed  Google Scholar 

  29. The general rules for the clinical and pathological study of primary liver cancer. Liver Cancer Study Group of Japan. Jpn J Surg. 1989;19:98–129.

  30. Utsunomiya T, Shimada M, Kudo M, et al. Nationwide study of 4741 patients with non-B non-C hepatocellular carcinoma with special reference to the therapeutic impact. Ann Surg. 2014;259:336–45.

    Article  PubMed  Google Scholar 

  31. Yamada D, Kobayashi S, Wada H, et al. Role of crosstalk between interleukin-6 and transforming growth factor-beta 1 in epithelial-mesenchymal transition and chemoresistance in biliary tract cancer. Eur J Cancer. 2013;49:1725–40.

    Article  CAS  PubMed  Google Scholar 

  32. Fujimoto A, Totoki Y, Abe T, et al. Whole-genome sequencing of liver cancers identifies etiological influences on mutation patterns and recurrent mutations in chromatin regulators. Nat Genet. 2012;44:760–4.

    Article  CAS  PubMed  Google Scholar 

  33. Marubashi S, Dono K, Nagano H, et al. Detection of AFP mRNA-expressing cells in the peripheral blood for prediction of HCC recurrence after living donor liver transplantation. Transpl Int. 2007;20:576–82.

    Article  CAS  PubMed  Google Scholar 

  34. Marubashi S, Nagano H, Wada H, et al. Clinical significance of alpha-fetoprotein mRNA in peripheral blood in liver resection for hepatocellular carcinoma. Ann Surg Oncol. 2011;18:2200–9.

    Article  PubMed  Google Scholar 

Download references

Disclosure

None.

Author information

Authors and Affiliations

  1. Department of Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan

    Shigeru Marubashi MD, PhD, Kunihito Gotoh MD, PhD, Hirofumi Akita MD, PhD, Hidenori Takahashi MD, PhD, Keijiro Sugimura MD, Norikatsu Miyoshi MD, PhD, Masaaki Motoori MD, PhD, Kentaro Kishi MD, PhD, Shingo Noura MD, PhD, Yoshiyuki Fujiwara MD, PhD, Masayuki Ohue MD, PhD, Masahiko Yano MD, PhD, Osamu Ishikawa MD, PhD & Masato Sakon MD, PhD

  2. Department of Radiology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan

    Tetsuro Nakazawa MD, PhD & Katsuyuki Nakanishi MD, PhD

  3. Center for Cancer Control and Statistics, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan

    Yuri Ito PhD

Authors
  1. Shigeru Marubashi MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kunihito Gotoh MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Hirofumi Akita MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Hidenori Takahashi MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Keijiro Sugimura MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Norikatsu Miyoshi MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Masaaki Motoori MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Kentaro Kishi MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Shingo Noura MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Yoshiyuki Fujiwara MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Masayuki Ohue MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Tetsuro Nakazawa MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Katsuyuki Nakanishi MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Yuri Ito PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. Masahiko Yano MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  16. Osamu Ishikawa MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  17. Masato Sakon MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Shigeru Marubashi MD, PhD.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Marubashi, S., Gotoh, K., Akita, H. et al. Analysis of Recurrence Patterns After Anatomical or Non-anatomical Resection for Hepatocellular Carcinoma. Ann Surg Oncol 22, 2243–2252 (2015). https://doi.org/10.1245/s10434-014-4214-4

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-014-4214-4

Keywords

Search

Navigation