Anatomical versus non-anatomical resection for solitary hepatocellular carcinoma without macroscopic vascular invasion: A propensity score matching analysis.

Abstract The superiority of anatomical resection (AR) in patients with hepatocellular carcinoma compared with non-anatomical resection (NAR) remains controversial. We aimed to investigate the prognostic outcomes of AR and NAR for solitary HCC patients without macroscopic vascular invasion, using a propensity score matching (PSM) analysis. A total of 305 consecutive HCC patients without macroscopic vascular invasion underwent curative hepatectomy were included in our study. PSM was performed in order to eliminate possible selection bias. By PSM, the patients were divided into PS-AR (n = 114) and PS-NAR (n = 114) groups. The 1-, 3-, and 5-year OS rates were 90.4%, 77.7% and 65.7% in PS-AR and 88.6%, 70.7% and 52.2% in PS-NAR (P = 0.053), respectively. The 1-, 3-, and 5-year RFS rates were 84.1%, 64.9% and 45.1% in PS-AR and 75.4%, 48.1% and 31.0% in PS-NAR (P = 0.005), respectively. Multivariate analysis showed that ICG-R15 (P = 0.022), BCLC staging (P = 0.044) and MVI (P = 0.005) were independent risk factors for the overall survival (OS) rate, while type of resection (P = 0.027), surgical margin (P = 0.039) and MVI (P = 0.024) were independent risk factors for the recurrence-free survival (RFS) rate. Patients underwent NAR were prone to early recurrence and marginal recurrence. Patients underwent NAR were prone to early recurrence and marginal recurrence. Subgroup analysis indicated that the RFS rate was significantly better in PS-AR than that in PS-NAR (surgical margin ≥1 cm) (P = 0.025). Better RFS rate was observed in PS-AR with MVI compared to PS-NAR (P = 0.016). AR contributed to improve the RFS rate in solitary HCC patients without macroscopic vascular invasion using PSM analysis, especially in patients with MVI. This article is protected by copyright. All rights reserved.