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Effect of anatomical liver resection for hepatocellular carcinoma: a systematic review and meta-analysis.

ABSTRACT:

Background

Despite retrospective studies comparing anatomical liver resection (AR) and nonanatomical liver resection (NAR), the efficacy and benefits of AR for hepatocellular carcinoma (HCC) remain unclear.

Materials and methods

We systemically reviewed MEDLINE, Embase, and Cochrane Library for propensity score matched (PSM) cohort studies that compared AR and NAR for HCC. Primary outcomes were overall survival (OS) and recurrence-free survival (RFS). Secondary outcomes were recurrence patterns and perioperative outcomes.

Results

Overall, 22 PSM studies (AR, n=2,496; NAR, n=2,590) were included. AR including systemic segmentectomy was superior to NAR regarding the 3- and 5-year OS. AR showed significantly better 1-, 3-, and 5-year RFS than NAR, with low local and multiple intrahepatic recurrence rates. In the subgroup analyses of tumor diameter ≤5 cm and tumors with microscopic spread, the RFS in the AR group was significantly better than that in the NAR group. Patients with cirrhotic liver in the AR group showed comparable 3- and 5-year RFS with the NAR group. Postoperativeoverall complications were comparable between AR and NAR.

Conclusions

This meta-analysis demonstrated that AR showed better OS and RFS with a low local and multiple intra-hepatic recurrence rate than NAR, especially in patients with tumor diameter ≤5 cm and non-cirrhotic liver.

SUBMITTER: Shin SW

PROVIDER: S-EPMC10498869 | biostudies-literature | 2023 May

REPOSITORIES: biostudies-literature

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Project description:BackgroundLimited anatomical liver resection for hepatocellular carcinoma (HCC) is complicated in cirrhotic patients with centrally located HCC and limited liver reserve. We present a case of total laparoscopic left medial and right ventroanterior sectionectomy performed using the intrahepatic Glissonian approach in a cirrhotic liver for curative resection of HCC.MethodsThe patient was a 69-year-old man with a 6.5-cm-diameter HCC located at segments 4, 5, and 8 and which was compressing the middle hepatic vein (MHV). Child-Pugh class A liver cirrhosis was noted, and the 15-min retention rate for indocyanine green was 14 %. Preoperative surgical planning suggested the feasibility of limited anatomical subsegmental resection. The patient was placed in the supine position and 5 trocars were used for the procedure. The operation began with cholecystectomy, division of liver ligaments, and exposure of the right hepatic vein root and the umbilical Glissonian pedicles to the left medial segment. Parenchymal transection was performed using a laparoscopic harmonic scalpel and Cavitron Ultrasonic Surgical Aspirator until the MHV was reached. After exposing the ventral branches of the right anterior Glissonian pedicle and dividing them, resection was continued along the demarcation line. Fissure veins draining to the MHV root were identified and divided. The MHV root was closed using an automatic stapler.ResultsThe operation time was 565 min and estimated blood loss was 665 ml; blood transfusion was not required. Pathological examination confirmed a moderately differentiated HCC with all resected margins free of malignancy. Postoperative recovery was uneventful and the patient was discharged on the postoperative day 7. There was no tumor recurrence 18 months after the operation.ConclusionsTotal laparoscopic left medial and right ventroanterior sectionectomy via the intrahepatic Glissonian approach is feasible for HCC in a cirrhotic liver with limited liver reserve. Preoperative planning is essential in order to compute successful hepatic function. Standardization of surgical techniques may aid in safely performing this procedure.