Original Communication| Volume 143, ISSUE 4, P469-475, April 2008

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


      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 (DFS) still remains controversial.


      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.


      The overall DFS was significantly better after an AS (P = .0089). When the patients were stratified according to the size of the HCC, a better DFS 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.


      An AS is therefore recommended, especially when the size of HCC ranges from 2 to 5 cm.
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        • The Liver Cancer Study Group of Japan
        Primary liver cancer in Japan. Clinicopathologic features and results of surgical treatment.
        Ann Surg. 1990; 211: 277-287
        • The Liver Cancer Study Group of Japan
        Classification of primary liver cancer.
        First English Edition. Kanehara & Company. Ltd, Tokyo1997
        • Hasegawa K.
        • Kokudo N.
        • Imamura H.
        • et al.
        Prognostic impact of anatomic resection for hepatocellular carcinoma.
        Ann Surg. 2005; 242: 252-259
        • Kanematsu T.
        • Takenaka K.
        • Matsumata T.
        • et al.
        Limited hepatic resection effective for selected cirrhotic patients with primary liver cancer.
        Ann Surg. 1984; 199: 51-56
        • Regimbeau J.M.
        • Kianmanesh R.
        • Farges O.
        • et al.
        Extent of liver resection influences the outcome in patients with cirrhosis and small hepaticellular carcinoma.
        Surgery. 2002; 131: 311-317
        • Kaibori M.
        • Matsui Y.
        • Hijikawa T.
        • et al.
        Comparison of limited and anatomic hepatic resection for hepatocellular carcinoma with hepatitis C.
        Surgery. 2006; 139: 385-394
        • Miyagawa S.
        • Kawasaki S.
        Subsegmentectomy or segmentectomy in hepatocellular carcinoma.
        Hepatogastroenterology. 1998; 45: 2-6
        • Makuuchi M.
        • Kosuge T.
        • Takayama T.
        • et al.
        Surgery for small liver cancers.
        Semin Surg Oncol. 1993; 9: 298-304
        • Makuuchi M.
        • Hasegawa H.
        • Yamazaki S.
        Ultrasonically guided subsegmentectomy.
        Surg Gynecol Obstet. 1986; 161: 346-350
        • Takasaki K.
        • Kobayashi S.
        • Tanaka S.
        • et al.
        Highly anatomically systematized hepatic resection with Glissonean sheath code transection at the hepatic hilus.
        Int Surg. 1990; 75: 73-77
        • Takano S.
        • Oishi S.
        • Kono S.
        • et al.
        Retrospective analysis of type of hepatic resection for hepatocellular carcinoma.
        Br J Surg. 2000; 87: 65-70
        • Ikai I.
        • Arii S.
        • Kojiro M.
        • et al.
        Reevaluation of prognostic factors for survival after liver resection in patients with hepatocellular carcinoma in a Japanese Nationwide Survey.
        Cancer. 2004; 101: 796-802
        • Nagasue N.
        • Yamanoi A.
        • el-Assal O.N.
        • et al.
        Major compared with limited hepatic resection for hepatocellular carcinoma without underlying cirrhosis: a retrospective analysis.
        Eur J Surg. 1999; 165: 638-646