Published online Feb 21, 2017. doi: 10.3748/wjg.v23.i7.1139
Peer-review started: August 31, 2016
First decision: September 20, 2016
Revised: October 18, 2016
Accepted: November 14, 2016
Article in press: November 16, 2016
Published online: February 21, 2017
Processing time: 177 Days and 17.8 Hours
Hepatocellular carcinoma (HCC) is the sixth most common type of cancer and the third most frequent cause of cancer-related death. Advances in preoperative assessment of HCC (e.g., imaging studies and liver function tests), surgical techniques, and postoperative care have improved the surgical outcomes and survival of patients who undergo hepatic resection for HCC. However, in the last 20 years, the long-term survival after hepatectomy has remained unsatisfactory owing to the high rates of local recurrence and multicentric occurrence. Anatomical liver resection (AR) was introduced in the 1980s. Although several studies have revealed tangible benefits of AR for HCC, these benefits are still debated. Because most HCCs occur in patients with liver cirrhosis and poor hepatic function, there are many factors that affect survival, including the surgical method. Nevertheless, many studies have documented the perioperative and long-term benefits of AR in various conditions. In this article, we review the results of several recently published, well-designed comparative studies of AR, to investigate whether AR provides real benefits on survival outcomes. We also discuss the potential pitfalls associated with this approach.
Core tip: Anatomical liver resection (AR) has been widely used for two decades in hepatocellular carcinoma and although many studies have shown the perioperative benefits, long term survival benefit of AR is still debated. For evaluation of benefits of AR, many factors should be considered, such as degree of cirrhosis, anatomical variation and surgical techniques. Moreover, critical review of previous studies considering bias is necessary. In this article, we review the results of several recently published, well-designed comparative studies of AR to investigate whether AR provides real benefits on survival outcomes. We also discuss the potential pitfalls associated with this approach.