Comparison of the outcomes between an anatomical subsegmentectomy and a non-anatomical minor hepatectomy for single hepatocellular carcinomas based on a Japanese nationwide survey

Background. Although a surgical resection is an important modality for the treatment of hepatocellular carcinoma (HCC), the impact of the operative method on both the patient survival and disease-free survival (DTS) still remains controversial. Methods. Using a nationwide Japanese database, 72,744 patients with HCC who underwent a curative liver resection between 1994 and 2001 were divided into two groups based on whether an anatomical subsegmentectomy (AS) or a non-anatomical minor hepatectomy (MH) was performed. A total of 5, 781 patients with single HCCs were selected for the study and divided into 3 subgroups based on the size of the HCCs (less than 2cm, 2 to 5 cm, and greater than 5 cm in diameter). An AS was performed for 2,267 patients while an MH was performed for 3,514 patients. Results. The overall DTS was significantly better after an AS (P = .0089). When the patients were stratified according to the size of the HCC, a better DES was seen in the patients with HCC from 2 to 5 cm after an AS (P < .0005). Further stratification according to liver damage did not show any significant differences between an AS and an MH. Conclusion. An AS is therefore recommended, especially when the size of HCC ranges from 2 to 5 cm.