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
At present, most studies suggest that anatomical resection is more effective than non-anatomical resection in the tumor diameter ranging from 2 cm to 5 cm. However, for tumors smaller than 2 cm and larger than 5 cm in diameter, the advantage of anatomic hepatectomy is not significant. Why is that? Does anatomic resection (AR) have an advantage over non-anatomic resection (NAR) in hepatocellular carcinoma (HCC) patients with microvascular invasion (MVI)?
Our study aimed to determine the effects of AR and NAR in different tumor diameter stratification. Further analysis shows that AR improves patient outcomes by obtaining a wider surgical margin.
This study compared the efficacy of AR and NAR in different tumor diameter subgroups in a prospective cohort study.
First, all patients were randomized to receive standard anatomic or non-anatomic resection. After surgery, we measured the surgical margin and identified micro
When the tumor is enormous and the remaining liver tissue is insufficient, AR may not be appropriate. For patients with a tumor diameter of 2-5 cm, AR can achieve the removal of peritumoral MVI by obtaining a wide incision margin, reducing post
The doctor should ensure sufficient surgical margin on the premise of ensuring the safety of the operation. Therefore, for patients with a tumor diameter of 2-5 cm, AR should be strongly recommended.
The study could guide doctors in their choice of surgical procedures. In general, AR guarantees a wider surgical margin. However, a wider surgical margin means that more healthy liver tissue has to be removed. Almost all patients with HCC have liver cirrhosis, and the excessive removal of non-neoplastic liver parenchyma can lead to liver dysfunction and the morbidities of ascites, jaundice, and hypoalbuminemia. When the tumor is enormous and the remaining liver tissue is insufficient, AR may not be appropriate.