Clinical Analysis of Anatomical Resection for the Treatment of Hepatocellular Carcinoma Based on the Stratification of Liver Function
Yusuke Yamamoto
Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, 6028566 Kyoto, Japan
Search for more papers by this authorCorresponding Author
Hisashi Ikoma
Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, 6028566 Kyoto, Japan
[email protected]Search for more papers by this authorRyo Morimura
Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, 6028566 Kyoto, Japan
Search for more papers by this authorHirotaka Konishi
Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, 6028566 Kyoto, Japan
Search for more papers by this authorYasutoshi Murayama
Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, 6028566 Kyoto, Japan
Search for more papers by this authorShuhei Komatsu
Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, 6028566 Kyoto, Japan
Search for more papers by this authorAtsushi Shiozaki
Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, 6028566 Kyoto, Japan
Search for more papers by this authorYoshiaki Kuriu
Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, 6028566 Kyoto, Japan
Search for more papers by this authorTakeshi Kubota
Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, 6028566 Kyoto, Japan
Search for more papers by this authorMasayoshi Nakanishi
Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, 6028566 Kyoto, Japan
Search for more papers by this authorDaisuke Ichikawa
Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, 6028566 Kyoto, Japan
Search for more papers by this authorHitoshi Fujiwara
Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, 6028566 Kyoto, Japan
Search for more papers by this authorKazuma Okamoto
Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, 6028566 Kyoto, Japan
Search for more papers by this authorChouhei Sakakura
Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, 6028566 Kyoto, Japan
Search for more papers by this authorToshiya Ochiai
Department of Surgery, North Medical Center Kyoto Prefectural University of Medicine, 481 Yosanocho, Yosagun, 6292261 Kyoto, Japan
Search for more papers by this authorEigo Otsuji
Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, 6028566 Kyoto, Japan
Search for more papers by this authorYusuke Yamamoto
Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, 6028566 Kyoto, Japan
Search for more papers by this authorCorresponding Author
Hisashi Ikoma
Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, 6028566 Kyoto, Japan
[email protected]Search for more papers by this authorRyo Morimura
Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, 6028566 Kyoto, Japan
Search for more papers by this authorHirotaka Konishi
Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, 6028566 Kyoto, Japan
Search for more papers by this authorYasutoshi Murayama
Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, 6028566 Kyoto, Japan
Search for more papers by this authorShuhei Komatsu
Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, 6028566 Kyoto, Japan
Search for more papers by this authorAtsushi Shiozaki
Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, 6028566 Kyoto, Japan
Search for more papers by this authorYoshiaki Kuriu
Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, 6028566 Kyoto, Japan
Search for more papers by this authorTakeshi Kubota
Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, 6028566 Kyoto, Japan
Search for more papers by this authorMasayoshi Nakanishi
Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, 6028566 Kyoto, Japan
Search for more papers by this authorDaisuke Ichikawa
Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, 6028566 Kyoto, Japan
Search for more papers by this authorHitoshi Fujiwara
Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, 6028566 Kyoto, Japan
Search for more papers by this authorKazuma Okamoto
Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, 6028566 Kyoto, Japan
Search for more papers by this authorChouhei Sakakura
Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, 6028566 Kyoto, Japan
Search for more papers by this authorToshiya Ochiai
Department of Surgery, North Medical Center Kyoto Prefectural University of Medicine, 481 Yosanocho, Yosagun, 6292261 Kyoto, Japan
Search for more papers by this authorEigo Otsuji
Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, 6028566 Kyoto, Japan
Search for more papers by this authorAbstract
Background
This study aimed to clarify the efficacy of anatomical resection (AR) for the treatment of hepatocellular carcinoma (HCC) compared with that of nonanatomical resection (NAR) based on the stratification of liver function (LF).
Methods
The clinical records of 174 patients with a single HCC, 2–5 cm in diameter and without macroscopic vascular invasion, were analyzed. AR was performed in 132 patients and NAR was performed in 42 patients. The indocyanine green retention rate at 15 min (ICGR15) of the 78 patients classified as the good-LF group was 10–20 % and the ICGR15 of the 54 patients classified as the poor-LF group was 20–40 %.
Results
The 5-year overall survival (OS) and disease-free survival rates of the 174 patients were 67.6 and 33.4 %, respectively. Cox proportional hazard analysis identified ICGR15 ≥20 %, liver cirrhosis, α-fetoprotein ≥100 mg/dL, and infiltrating growth as independent prognostic factors. Liver cirrhosis was significantly less frequent in patients who underwent AR than in patients who underwent NAR (52 vs. 79 %, p = 0.002). In the subgroup analysis of the good-LF group, there were no significant differences in 5-year OS after AR and NAR (73.3 vs. 65.2 %, p = 0.857). By contrast, in the subgroup analysis of the poor-LF group, the 5-year OS after AR was significantly worse than after NAR (45.3 vs. 77.4 %, p = 0.044).
Conclusion
In patients with an ICGR15 ≥20 %, we recommend NAR rather than AR for the treatment of a solitary 2–5-cm-diameter HCC and without macroscopic vascular invasion.
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