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
ARTICLE HIGHLIGHTS
Research background
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)?
Research motivation
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.
Research objectives
This study compared the efficacy of AR and NAR in different tumor diameter subgroups in a prospective cohort study.
Research methods
First, all patients were randomized to receive standard anatomic or non-anatomic resection. After surgery, we measured the surgical margin and identified microvascular invasion. We divided them into three groups based on tumor size.
Research results
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 postoperative recurrence and improving prognosis. For patients with a tumor of less than 2 cm in diameter, both AR and NAR can obtain a wide surgical margin to ensure the removal of MVI. AR should not be recommended for those patients. For patients with tumors larger than 5 cm in diameter, neither AR nor NAR could obtain a wide surgical margin to ensure removal of MVI.
Research conclusions
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.
Research perspectives
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.
