| Background and Objective:The impact of anatomic resection (AR) between non-anatomic resection (NAR) for hepatocellular carcinoma (HCC) as factors of preventing intra-hepatic recurrence and local recurrence on HCC patients after the initial surgical procedure remains controversial. This study is a systemic review of available evidence.Methods:A systematic review of nonrandomized trials comparing anatomic resection with non-anatomic resection for HCC published from 1990 to 2011 in PubMed and Medline, Cochrane Library, Embase, and Science Citation Index were searched. Intra-hepatic recurrence, including early and late recurrence, and local recurrence were considered as primary outcomes.5 years survival and 5 years disease-free survival were considered as secondary outcomes. Pooled effect was calculated by utilizing either fixed effects model or random effects model.Result:Eleven nonrandomized studies including 1,576 patients were identified and analyzed.810 patients were in the AR group and 766 were in the NAR group. Patients in the AR group were characterized by lower prevalence of cirrhosis, more favorable hepatic function, and larger tumor size and higher prevalence of macrovascular invasion compared with patients in the NAR group. Anatomic resection significantly reduced the risks of local recurrence and achieved a better 5 years disease-free survival in the HCC patients. Also, anatomic resection was effective of decreasing the early intra-hepatic recurrence marginally. However, anatomic resection was not advantageous in preventing late intra-hepatic recurrence compared with nonanatomic resection. No differences were found between AR and NAR with respect to postoperative morbidity, mortality, and hospitalization.Conclusion:Anatomic resection was recommended to be superior to nonanatomic resection in terms of reducing the risks of local recurrence, early intra-hepatic recurrence and achieving a better 5 years disease-free survival in the HCC patients. |
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