Recurrence after Anatomic Resection Versus Nonanatomic Resection for Hepatocellular Carcinoma: A Meta-analysis

The impact of anatomic resection (AR) as compared to non-anatomic resection (NAR) for hepatocellularcarcinoma (HCC) as a factor for preventing intra-hepatic and local recurrence after the initial surgical procedureremains controversial. A systematic review and meta-analysis of nonrandomized trials comparing anatomicresection with non-anatomic resection for HCC published from 1990 to 2010 in PubMed and Medline, CochraneLibrary, Embase, and Science Citation Index were therefore performed. Intra-hepatic recurrence, including earlyand late, and local recurrence were considered as primary outcomes. As secondary outcomes, 5 year survivaland 5 year disease-free survival were considered. Pooled effects were calculated utilizing either fixed effects orrandom effects models. Eleven non-randomized studies including 1,576 patients were identified and analyzed,with 810 patients in the AR group and 766 in the NAR group. Patients in the AR group were characterized bylower prevalence of cirrhosis, more favorable hepatic function, and larger tumor size and higher prevalence ofmacrovascular invasion compared with patients in the NAR group. Anatomic resection significantly reducedthe risks of local recurrence and achieved a better 5 years disease-free survival. Also, anatomic resection wasmarginally effective for decreasing the early intra-hepatic recurrence. However, it was not advantageous inpreventing late intra-hepatic recurrence compared with non-anatomic resection. No differences were foundbetween AR and NAR with respect to postoperative morbidity, mortality, and hospitalization. Anatomic resectioncan be recommended as superior to non-anatomic resection in terms of reducing the risks of local recurrence,early intra-hepatic recurrence and achieving a better 5 year disease-free survival in HCC patients.