Long-term Outcomes of Anatomical Resection for Hepatocellular Carcinoma: a Propensity Score Matching Analysis

Abstract Objective: To compare anatomical resection (AR) and non-anatomical resection (NAR) in terms of postoperative outcomes and long-term survival in patients of hepatocellular carcinoma (HCC).Summary Background Data: HCC is a common cancer and studies of AR versus NAR for HCC had contradictory findings.Methods: Data of patients having AR or NAR for HCC in 2000-2015 were reviewed. Propensity-score matching (AR:NAR, 2:1) was performed to match the two groups in liver function and tumor number, size, and marker. The two matched groups were compared in terms of tumor characteristics, operative details, postoperative and oncological outcomes, and survival.Results: After matching, there were 382 patients in AR group and 191 patients in NAR group. AR group had fewer minor resections (p<0.001) and laparoscopic resections (11% vs 19.4%, p=0.006), more blood loss (0.565 vs 0.335 L, p<0.001) and transfusion (9.2% vs 3.7%, p<0.001), longer operations (353 vs 214 min, p<0.001) and hospitalization (p<0.001), more macrovascular involvement (4.2% vs 0%, p=0.004), fewer recurrences (p=0.003), longer disease-free period (52.9 vs 39.2 months, p=0.041), and better disease-free survival (p=0.012). The groups were comparable in complication and overall survival (p=0.377). On multivariate analysis, macrovascular involvement (HR 3.689, 95% CI 2.099-6.485, p<0.01) and NAR (HR 0.796, 95% CI 0.640-0.989, p=0.039) were independent risk factors for disease-free survival.Conclusions: For HCC, AR showed a benefit in disease-free survival but not overall survival, while NAR resulted in a better postoperative profile.