Clinical Outcome of Hepatectomy for Hepatocellular Carcinomas ≤2 cm

Background The treatment strategy for hepatocellular carcinomas (HCCs) ≤2 cm (HCC2−) is still controversial. In this study, we retrospectively analyzed clinicopathological data for HCC2− and HCCs >2 cm (HCC2+) to establish the treatment strategy for HCC2−. Methods Between April 2000 and December 2008, 206 patients with single HCC, who underwent hepatectomy for the first time, and whose outcomes could be tracked, were included in the study. There were 46 HCC2− and 160 HCC2+ patients. Survival and disease-free survival rates were compared between the two groups, in relation to various clinicopathological data. Results The 1-, 3-, and 5-year overall survival rates were 100%, 92.6%, and 72.8% for HCC2− and 93.3%, 72.4%, and 57% for HCC2+, respectively ( P = 0.0098). The 1, 3, and 5-year disease-free survival rates were 86%, 42.6%, and 31% for HCC2−, and 64.7%, 35.9%, and 12.5% for HCC2+, respectively ( P = 0.0642). Survival rates were better for HCC2− than for HCC2+ in terms of abnormal serum des-gamma-carboxy prothrombin, Child-Pugh Class A, single infection with HBV or HCV, and operative method used for anatomical resection, irrespective of ICG R15. Disease-free survival rates were better for HCC2- than for HCC2+ in terms of Child-Pugh Class A, and operative method used for anatomical resection. Conclusions HCC2− has a better clinical outcome than HCC2+ after hepatic resection. Especially, HCC2− with an abnormal DCP value, Child-Pugh Class A, single infection with HBV or HCV, and anatomical resection, yields better outcomes. Even for HCC2− in patients with good liver function, anatomical resection is recommended.