Department of General Surgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, 100730, China; Peking University Fifth School of Clinical Medicine, Beijing, 100730, China.
Department of General Surgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, 100730, China.
Asian J Surg. 2021 Sep;44(9):1143-1150. doi: 10.1016/j.asjsur.2021.02.023. Epub 2021 Mar 23.
The efficacy of anatomical resection (AR) and non-anatomical resection (NR) in the treatment of hepatocellular carcinoma (HCC) patients with microvascular invasion (MVI) remains unknown. This study compared the safety and outcomes of these surgical procedures. A systematic literature search was conducted. The main outcomes were overall survival (OS), disease-free survival (DFS). Overall hazard ratio (HR) was calculated from Kaplan-Meier plots and outcomes using random-effects models. There was no significant difference in postoperative complications between the AR and NR groups (risk ratio [RR]: 0.92, 95% confidence interval [CI]: 0.72-1.17, p = 0.496). OS was higher with AR at 1 year (RR: 0.66, 95% CI: 0.45-0.98, p = 0.037), 3 years (RR: 0.64, 95% CI: 0.50-0.82, p = 0.000), and 5 years (RR: 0.76, 95% CI: 0.65-0.89, p = 0.001). AR was associated with a higher OS rate (HR: 0.62, 95% CI: 0.47-0.82, p = 0.001). AR was associated with improved DFS at 1 year (RR: 0.65, 95% CI: 0.52 to 0.82, p = 0.000), 3 years (RR: 0.75, 95% CI: 0.66 to 0.86, p = 0.000), and 5 years (95% CI: 0.75 to 0.94, p = 0.002). Compared with NR, AR had significant advantages on overall HR of DFS (HR: 0.64, 95% CI: 0.45 to 0.91, p = 0.012). In conclusion, AR was associated with higher rates of OS and DFS in HCC patients with MVI. Thus, for well-presented liver function HCC patients which are predicted to have positive MVI, AR is recommended.
解剖性切除术（AR）和非解剖性切除术（NR）治疗伴有微血管侵犯（MVI）的肝细胞癌（HCC）患者的疗效尚不清楚。本研究比较了这两种手术方法的安全性和结果。进行了系统的文献检索。主要结局是总生存（OS）、无病生存（DFS）。使用随机效应模型从 Kaplan-Meier 图和结果计算总体危险比（HR）。AR 组和 NR 组的术后并发症无显著差异（风险比 [RR]：0.92，95%置信区间 [CI]：0.72-1.17，p=0.496）。AR 组的 1 年（RR：0.66，95%CI：0.45-0.98，p=0.037）、3 年（RR：0.64，95%CI：0.50-0.82，p=0.000）和 5 年（RR：0.76，95%CI：0.65-0.89，p=0.001）OS 更高。AR 与更高的 OS 率相关（HR：0.62，95%CI：0.47-0.82，p=0.001）。AR 与 1 年（RR：0.65，95%CI：0.52-0.82，p=0.000）、3 年（RR：0.75，95%CI：0.66-0.86，p=0.000）和 5 年（95%CI：0.75-0.94，p=0.002）DFS 率的提高相关。与 NR 相比，AR 在 DFS 的总体 HR 方面具有显著优势（HR：0.64，95%CI：0.45-0.91，p=0.012）。总之，AR 与 MVI 阳性 HCC 患者的 OS 和 DFS 率较高相关。因此，对于具有良好肝功能且预计 MVI 阳性的 HCC 患者，推荐使用 AR。
