Zhou JM, Zhou CY, Chen XP, Zhang ZW. Anatomic resection improved the long-term outcome of hepatocellular carcinoma patients with microvascular invasion: A prospective cohort study. World J Gastrointest Oncol 2021; 13(12): 2190-2202 [PMID: 35070051 DOI: 10.4251/wjgo.v13.i12.2190]
Corresponding Author of This Article
Zhi-Wei Zhang, PhD, Professor, Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1095 Jiefang Avenue, Wuhan 430030, Hubei Province, China. zhiweizhangtjh@163.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Prospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Jiang-Min Zhou, Chen-Yang Zhou, Zhi-Wei Zhang, Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
Xiao-Ping Chen, Translational Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
Author contributions: Zhou JM analyzed and interpreted the patient data and wrote the manuscript; Zhou CY managed the patients, including recruiting patients, performing operations, and following-up with the patients; Zhang ZW and Chen XP designed the experiment and modified the manuscript; all authors read and approved the final manuscript.
Supported byThe National Key Research and Development Program of China, No. 2016YFC0106004.
Institutional review board statement: The study was reviewed and approved for publication by Institutional Reviewer of Huazhong University of Science and Technology.
Informed consent statement: All study participants or their legal guardian provided informed written consent about personal and medical data collection prior to study enrolment.
Conflict-of-interest statement: All the authors have no conflict of interest related to the manuscript.
Data sharing statement: The original anonymous dataset is available on request from the corresponding author at zhiweizhangtjh@163.com.
CONSORT 2010 statement: The authors have read the CONSORT 2010 Statement, and the manuscript was prepared and revised according to the CONSORT 2010 Statement.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Zhi-Wei Zhang, PhD, Professor, Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1095 Jiefang Avenue, Wuhan 430030, Hubei Province, China. zhiweizhangtjh@163.com
Received: May 26, 2021 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 Processing time: 202 Days and 13 Hours
Abstract
BACKGROUND
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.
AIM
To explore whether AR improves long-term survival in patients with hepatocellular carcinoma (HCC) by removing the peritumoral MVI.
METHODS
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.
RESULTS
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).
CONCLUSION
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.
