Anatomical resection of hepatocellular carcinoma: A critical review of the procedure and its benefits on survival

Table 1 Summary of studies comparing the outcomes of anatomical and non-anatomical resection in patients with hepatocellular carcinoma

Ref.	Study period	Patient number total(AR:NAR)	Inclusion criteria	Method ofAR	Cirrhosis(yes/no)	Bleeding amount (mL, AR:NAR)	Survival benefit of AR for OS and RFS	Recurrence pattern (local or multicentric)	Others
				D:Dye injection	ICG R15
				G:Glissonian	Difference
					B/W AR and NAR
Benefit
Yamamoto et al[18]	1990-1994	n = 204 (90:114)	Solitary ≤ 5 cm	Glissonian	P = 0.02	Not shown	Yes	NA
					NA		OS (P = 0.0002)
Regimbeau et al[7]	1990-1996	n = 64 (30:34)	Solitary < 4 cm	Glissonean + US	NA	Not shown	Yes	NA
					NA		OS and RFS (P < 0.05)
Hasegawa et al[12]	1994-2001	n = 210 (156:54)	Solitary	Dye injection	0.002	P = 0.8 (574: 560)	Yes	NA
					P < 0.0001		OS (P = 0.01)
							RFS (P = 0.006)
Cho et al[38]	1998-2001	n = 168 (99:69)	Solitary ≤ 5 cm	Not described	P = 0.026	Not shown	Yes	NA
					NA		OS (P = 0.032)
							RFS (P = 0.003)
Wakai et al[15]	1990-2004	n = 158 (95:63)	Solitary pT1-T2	Glissonean	P = 0.015 AR < NAR	P = 0.017 (813:590)	Yes	NA
					P = 0.001		OS (P = 0.03) RFS (P = 0.008), for pT2 OS (P = 0.001) and RFS (P = 0.0004)
Yamashita et al[25]	1985-2004	n = 321 (201:120)	Solitary	Glissonean	P < 0.01	P < 0.01 (1353:993)	Yes	NA
					P < 0.01		OS and RFS (P = 0.01) for liver damaged, No for less damaged
Ueno et al[37]	1990-2004	n = 116 (52:64)	≤ 3 nodules, ≤ 3 cm	Dye injection	NA	P = 0.46 (1609:1224)	No for OS (P = 0.19)	NA
					P = 0.006		Yes for RFS (P < 0.03)
Kobayashi et al[33]	1990-2004	n = 233 (106:127)	Solitary	Dye injection	P < 0.0001	NA	Yes	Different
					P < 0.0001		RFS (P = 0.0002)	local recu: AR < NAR (P < 0.002)
Eguchi et al[31]	1994-2001	n = 5781 (2267:3514)	Mixed	D&G mixed	NA	Not shown	Yes	NA	Japanese nationwide survey
							OS (P = 0.0529)
							RFS (P = 0.0089)
Yamazaki et al[26]	1994-2007	n = 209 (111:98)	Solitary ≤ 5 cm	Glissonean	P = 0.003	P < 0.0001 (1266:842)	Yes	NA
					NA		OS (P = 0.004),
							RFS (P = 0.023)
No benefit
Capussotti et al[30]	1985-2001	n = 216 (156:60)	No limitation	Not clear	NA	Not shown	No OS (P = 0.9)	NA
Portolani et al[36]	1986-2003	n = 213 (131:82)	NA	Not described	NA	Not shown	No	NA
					NA
Tanaka et al[14]	1992-2005	n = 125 (83:42)	Solitary	Not clear	P = 0.035	P = 0.23 (1000:1200)	No	No diff (P = 0.39)
					NA		OS (P = 0.34)
Kaibori et al[13]	1992-2003	n = 237 (34:217)	HepC(+)	Dye injection	P = 0.006	0.27 (1779:1414)	No	No diff (P = 0.12)
							(OS = 0.7 and DFS 0.76)
Tomimaru et al[27]	1990-2008	n = 92 (30:62)	Solitary ≤ 3 cm	Not clear	P = 0.4	P = 0.03 (1112:756)	No	No diff (P = 0.29)
					P = 0.7		OS (P = 0.67)
							RFS (P = 0.77)
Ahn et al[22]	2001-2011	n = 140 (65:75)	Solitary	Dye injection	P = 0.008	P = 0.05 (410:559)	No	NA	Segmentectomy vs NAR
					P < 0.001		OS (P = 0.08)
Marubashi et al[34]	2001-2012	n = 424 (243:181)	No limitation	Dye injection	NA	P < 0.001 (1237:640)	No	No diff (P = 0.23)	No difference in recurrence pattern
					P < 0.001		RFS P = 0.3
Yamamoto et al[29]	2003-2013	n = 44 (16:28)	Solitary	Dye injection	0.005	P = 0.002	No	NA
					P = 0.029	(711:222)	OS (P = 0.6), DFS (0.58)
							Yes for HBsAg(+) (P = 0.008)

AR: Anatomical resection; NAR: Non-anatomical resection; D: Dye injection method; G: Glissonean pedicle method; ICG R15: Indocyanine green retention rate at 15 min; B/W: Between; OS: Overall survival; RFS: Recurrence-free survival; NA: Not applicable; US: Ultrasound; DFS: Disease-free survival; diff: Difference; HBsAg: Hepatitis B surface antigen.

Table 2 Summary of case-control studies using the propensity score matching method to compare the outcomes of anatomical and non-anatomical resection for hepatocellular carcinoma

Ref.	Study period	Patient total number and after propensity score matched (AR:NAR)	Inclusion criteria	Method of AR	ICG R15	Bleeding amount	Survival benefit of AR
				D:Dye injection	Difference	(mL, AR:NAR)
				G:Glissonian	B/W AR and NAR
Okamura et al[35], 2014	2002-2013	n = 236 (139:97 and 64:64)	Solitary	Dye injection	P = 0.07	P = 0.008 (551:465)	No
							RFS (P = 0.52)
Ishii et al[32], 2014	2002-2010	n = 268 (110:158 and 44:44)	Solitary ≤ 5 cm	Not Clear	P = 0.053	0.9 (400:355)	No
							OS (P = 0.29) RFS (P = 0.28)
Marubashi et al[28], 2015	1981-2012	n = 1102 (577:525 and 329:329)	No limitation	Not clear	NA	Not shown	No
							OS (P = 0.7) and RFS (P = 0.4)

AR: Anatomical resection; NAR: Non-anatomical resection; D: Dye injection method; G: Glissonean pedicle method; ICG R15: Indocyanine green retention rate at 15 min; B/W: Between; OS: Overall survival; RFS: Recurrence-free survival; NA: Not applicable.