Impact of systematic segmentectomy for small hepatocellular carcinoma

Background We compared survival after resection by systematic segmentectomy (SS) versus non‐anatomic resection (NAR) in patients with small, solitary hepatocellular carcinomas (HCCs). Methods To control for variables, we used 1‐to‐1 propensity score matching to compare outcomes after surgery among 615 patients in Japan between 2003 and 2007 with primary solitary HCCs ≤3 cm in diameter who received SS (n = 114) or NAR (n = 114) of one Couinaud segment with complete removal of the portal territory containing the tumor. Results We successfully matched SS and NAR patients with primary HCC tumors ≤3.0 cm and similar liver function and tumor characteristics. The SS group had significantly longer recurrence‐free survival (RFS; hazard ratio [HR] 1.56, 95% confidence interval [CI] 1.10‐2.21, P = .013) and overall survival (OS; HR 1.67, 95% CI 1.07‐2.60, P = .025) than the NAR group. Among patients who lost >400 mL of blood during surgery, had chronic hepatitis, or had cirrhosis, the RFS and OS were better in the SS group than in the NAR group. In Cox proportional hazard analysis, SS offered a better prognosis than NAR. Conclusions Systematic segmentectomy decreases the risk of recurrence and improves OS in patients with primary, solitary HCC tumors of ≤3 cm in diameter. Highlight Kaibori and colleagues compared survival after systematic segmentectomy versus non‐anatomic resection in patients with hepatocellular carcinoma. Propensity score analysis successfully matched patients with similar liver function and tumor characteristics. Systematic segmentectomy decreased recurrence risk and improved overall survival in patients with single, primary hepatocellular carcinoma tumors