Complete removal of the tumor-bearing portal territory decreases local tumor recurrence and improves disease-specific survival of patients with hepatocellular carcinoma

Background & Aims: Anatomic resection (AR) of the tumor-bearing portal territory has been reported to be associated with a decreased recurrence of hepatocellular carcinoma (HCC). However, because of the heterogeneity of the study populations, its oncologic advantage remains controversial. The objective of the present study was to determine the clinical advantage of AR for primary HCC, based on the data from a large prospective cohort treated under a constant surgical policy. Methods: In 209 Child-Pugh class A patients with primary, solitary HCC measuring 65.0 cm in diameter, which was resectable either by AR or limited resection (non-AR), the overall survival (OS) and disease-free survival (DFS) were compared with patients in whom complete AR was achieved and those who eventually ended up with non-AR after adjustment for the propensity scores to select AR. Advantages of AR in disease-specific survival and local recurrence were also evaluated by competing-risks regression to clarify the true oncologic impact of AR. Results: The AR group showed better DFS than the non-AR group (HR, 0.67; 95% CI, 0.45-0.99; p = 0.046), while no significant difference was observed in OS (hazard ratio [HR], 0.82; 95% CI, 0.46-1.48; p = 0.511). Competing-risks regression revealed that AR significantly decreases local recurrence (HR, 0.12; 95% CI, 0.05-0.30; p < 0.001) and improves disease-specific survival (HR, 0.50; 95% CI, 0.28-0.90; p = 0.020), while the other cause of death was highly influenced by patient age (> 65 years) (HR, 7.51; 95% CI, 2.16-26.04; p = 0.002) and not associated with AR. Conclusion: Complete removal of tumor-bearing portal territory decreases the risk of local recurrence and death from HCC. (C) 2015 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.