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World J Gastroenterol. Feb 21, 2017; 23(7): 1139-1146
Published online Feb 21, 2017. doi: 10.3748/wjg.v23.i7.1139
Anatomical resection of hepatocellular carcinoma: A critical review of the procedure and its benefits on survival
Koo Jeong Kang, Keun Soo Ahn
Koo Jeong Kang, Keun Soo Ahn, Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, School of Medicine, Keimyung University Dong-san Medical Center, Daegu 41931, South Korea
Author contributions: Kang KJ and Ahn KS designed the review and collected and analyzed data; Kang KJ wrote the manuscript; Ahn KS revised the manuscript.
Conflict-of-interest statement: No potential conflicts of interest.
Open-Access: 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/
Correspondence to: Koo Jeong Kang, MD, PhD, Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, School of Medicine, Keimyung University Dong-san Medical Center, 56 Dalseong-Ro, Jung-Gu, Daegu 41931, South Korea. kjkang@dsmc.or.kr
Telephone: +82-53-2507655 Fax: +82-53-2507322
Received: August 27, 2016
Peer-review started: August 31, 2016
First decision: September 20, 2016
Revised: October 18, 2016
Accepted: November 14, 2016
Article in press: November 16, 2016
Published online: February 21, 2017
Abstract

Hepatocellular carcinoma (HCC) is the sixth most common type of cancer and the third most frequent cause of cancer-related death. Advances in preoperative assessment of HCC (e.g., imaging studies and liver function tests), surgical techniques, and postoperative care have improved the surgical outcomes and survival of patients who undergo hepatic resection for HCC. However, in the last 20 years, the long-term survival after hepatectomy has remained unsatisfactory owing to the high rates of local recurrence and multicentric occurrence. Anatomical liver resection (AR) was introduced in the 1980s. Although several studies have revealed tangible benefits of AR for HCC, these benefits are still debated. Because most HCCs occur in patients with liver cirrhosis and poor hepatic function, there are many factors that affect survival, including the surgical method. Nevertheless, many studies have documented the perioperative and long-term benefits of AR in various conditions. In this article, we review the results of several recently published, well-designed comparative studies of AR, to investigate whether AR provides real benefits on survival outcomes. We also discuss the potential pitfalls associated with this approach.

Keywords: Hepatocellular carcinoma, Cirrhosis, Curative, Anatomical resection, Prognosis

Core tip: Anatomical liver resection (AR) has been widely used for two decades in hepatocellular carcinoma and although many studies have shown the perioperative benefits, long term survival benefit of AR is still debated. For evaluation of benefits of AR, many factors should be considered, such as degree of cirrhosis, anatomical variation and surgical techniques. Moreover, critical review of previous studies considering bias is necessary. In this article, we review the results of several recently published, well-designed comparative studies of AR to investigate whether AR provides real benefits on survival outcomes. We also discuss the potential pitfalls associated with this approach.