Published online Dec 15, 2021. doi: 10.4251/wjgo.v13.i12.2190
Peer-review started: May 26, 2021
First decision: June 24, 2021
Revised: July 5, 2021
Accepted: September 15, 2021
Article in press: September 15, 2021
Published online: December 15, 2021
The long-term effect of anatomic resection (AR) is better than that of non-anatomic resection (NAR). At present, there is no study on microvascular invasion (MVI) and liver resection types.
To explore whether AR improves long-term survival in patients with hepatocellular carcinoma (HCC) by removing the peritumoral MVI.
A total of 217 patients diagnosed with HCC were enrolled in the study. The surgical margin was routinely measured. According to the stratification of different tumor diameters, patients were divided into the following groups: ≤ 2 cm group, 2-5 cm group, and > 5 cm group.
In the 2-5 cm diameter group, the overall survival (OS) of MVI positive patients was significantly better than that of MVI negative patients (P = 0.031). For the MVI positive patients, there was a statistically significant difference between AR and NAR (P = 0.027). AR leads to a wider surgical margin than NAR (2.0 ± 2.3 cm vs 0.7 ± 0.5 cm, P < 0.001). In the groups with tumor diameters < 2 cm, both AR and NAR can obtain a wide surgical margin, and the surgical margins of AR are wider than that of NAR (3.5 ± 5.8 cm vs 1.6 ± 0.5 cm, P = 0.048). In the groups with tumor diameters > 5 cm, both AR and NAR fail to obtain wide surgical margin (0.6 ± 1.0 cm vs 0.7 ± 0.4 cm, P = 0.491).
For patients with a tumor diameter of 2-5 cm, AR can achieve the removal of peritumoral MVI by obtaining a wide incision margin, reduce postoperative recurrence, and improve prognosis.
Core Tip: The prognosis of anatomic resection is better than that of non-anatomic resection with diameters from 2 to 5 cm. For tumor diameters smaller than 2 cm and larger than 5 cm, anatomic resection is not superior to non-anatomic resection. Anatomic resection can achieve the removal of peritumoral microvascular invasion by obtaining a wide incision margin. Both anatomic resection and non-anatomic resection can obtain wide surgical margins in the group with tumor diameters smaller than 2 cm. Both anatomic resection and non-anatomic resection failed to obtain wide surgical margins in the diameter larger than 5 cm group.