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Abstract：
BACKGROUND: The incidence of hepatocellular carcinoma (HCC) is increasing in the western world over the past decades. As liver resection (LR) represents one of the most efficient treatment options, advantages of anatomic (ALR) versus non-anatomic liver resection (NALR) show a lack of consistent evidence. Therefore, the aim of this study was to investigate complications and survival rates after both resection types.
METHODS: This is a multicentre cohort study using retrospectively and prospectively collected data. We included all patients undergoing LR for HCC between 2009 and 2020 from three specialised centres in Switzerland and Germany. Complication and survival rates after ALR versus NALR were analysed using uni- and multivariate Cox regression models.
RESULTS: Two hundred and ninety-eight patients were included. Median follow-up time was 52.76 months. 164/298 patients (55%) underwent ALR. Significantly more patients with cirrhosis received NALR (n = 94/134; p < 0.001). Complications according to the Clavien Dindo classification were significantly more frequent in the NALR group (p < 0.001). Liver failure occurred in 13% after ALR versus 8% after NALR (p < 0.215). Uni- and multivariate cox regression models showed no significant differences between the groups for recurrence free survival (RFS) and overall survival (OS). Furthermore, cirrhosis had no significant impact on OS and RFS.
CONCLUSIONS: No significant differences on RFS and OS rates could be observed. Post-operative complications were significantly less frequent in the ALR group while liver specific complications were comparable between both groups. Subgroup analysis showed no significant influence of cirrhosis on the post-operative outcome of these patients.
METHODS: This is a multicentre cohort study using retrospectively and prospectively collected data. We included all patients undergoing LR for HCC between 2009 and 2020 from three specialised centres in Switzerland and Germany. Complication and survival rates after ALR versus NALR were analysed using uni- and multivariate Cox regression models.
RESULTS: Two hundred and ninety-eight patients were included. Median follow-up time was 52.76 months. 164/298 patients (55%) underwent ALR. Significantly more patients with cirrhosis received NALR (n = 94/134; p < 0.001). Complications according to the Clavien Dindo classification were significantly more frequent in the NALR group (p < 0.001). Liver failure occurred in 13% after ALR versus 8% after NALR (p < 0.215). Uni- and multivariate cox regression models showed no significant differences between the groups for recurrence free survival (RFS) and overall survival (OS). Furthermore, cirrhosis had no significant impact on OS and RFS.
CONCLUSIONS: No significant differences on RFS and OS rates could be observed. Post-operative complications were significantly less frequent in the ALR group while liver specific complications were comparable between both groups. Subgroup analysis showed no significant influence of cirrhosis on the post-operative outcome of these patients.
摘要：
背景：在过去的几十年中，西方世界肝细胞癌（HCC）的发病率正在增加。由于肝切除术（LR）是最有效的治疗选择之一，解剖(ALR)与非解剖性肝切除术(NALR)的优势显示缺乏一致的证据.因此,这项研究的目的是调查两种切除类型后的并发症和生存率.
方法：这是一项多中心队列研究，使用回顾性和前瞻性收集的数据。我们纳入了2009年至2020年期间来自瑞士和德国三个专业中心的所有接受LR治疗HCC的患者。使用单和多变量Cox回归模型分析ALR与NALR后的并发症和生存率。
结果：纳入了二百九十八名患者。中位随访时间为52.76个月。164/298例患者(55%)接受ALR。显著更多的肝硬化患者接受NALR(n=94/134;p<0.001)。根据ClavienDindo分类的并发症在NALR组中明显更常见(p<0.001)。ALR后的肝功能衰竭发生率为13％，NALR后的肝功能衰竭发生率为8％（p<0.215）。单和多变量cox回归模型显示两组之间无复发生存期（RFS）和总生存期（OS）无显著差异。此外，肝硬化对OS和RFS无显著影响。
结论：可以观察到RFS和OS率没有显着差异。ALR组术后并发症的发生率明显较低，而两组之间的肝脏特异性并发症具有可比性。亚组分析显示，肝硬化对这些患者的术后结局没有显着影响。
方法：这是一项多中心队列研究，使用回顾性和前瞻性收集的数据。我们纳入了2009年至2020年期间来自瑞士和德国三个专业中心的所有接受LR治疗HCC的患者。使用单和多变量Cox回归模型分析ALR与NALR后的并发症和生存率。
结果：纳入了二百九十八名患者。中位随访时间为52.76个月。164/298例患者(55%)接受ALR。显著更多的肝硬化患者接受NALR(n=94/134;p<0.001)。根据ClavienDindo分类的并发症在NALR组中明显更常见(p<0.001)。ALR后的肝功能衰竭发生率为13％，NALR后的肝功能衰竭发生率为8％（p<0.215）。单和多变量cox回归模型显示两组之间无复发生存期（RFS）和总生存期（OS）无显著差异。此外，肝硬化对OS和RFS无显著影响。
结论：可以观察到RFS和OS率没有显着差异。ALR组术后并发症的发生率明显较低，而两组之间的肝脏特异性并发症具有可比性。亚组分析显示，肝硬化对这些患者的术后结局没有显着影响。
