Scientific Hepatectomy for Hepatocellular Carcinoma

Abstract

With advances in imaging technology and surgical instruments, hepatectomy can be perfectly performed with technical precision for hepatocellular carcinoma (HCC). However, the 5-year tumor recurrence rates remain greater than 70%. Thus, the strategy for hepatectomy needs to be reappraised based on insights of scientific advances. Scientific evidence has suggested that the main causes of recurrence after hepatectomy for HCC are mainly related to underlying cirrhosis and the vascular spread of tumor cells that basically cannot be eradicated by hepatectomy. Liver transplantation and systemic therapy could be the solution to prevent postoperative recurrence in this regard. Therefore, determining the severity of liver cirrhosis for choosing the appropriate surgical modality, such as liver transplantation or hepatectomy, for HCC and integrating newly emerging immune-related adjuvant and/or neoadjuvant therapy into the strategy of hepatectomy for HCC have become new aspects of exploration to optimize the strategy of hepatectomy. In this new area, hepatectomy for HCC has evolved from a pure technical concept emphasizing anatomic resection into a scientific concept embracing technical considerations and scientific advances in underlying liver cirrhosis, vascular invasion, and systemic therapy. By introducing the concept of scientific hepatectomy, the indications, timing, and surgical techniques of hepatectomy will be further scientifically optimized for individual patients, and recurrence rates will be decreased and long-term survival will be further prolonged.

Keywords

hepatocellular carcinoma / scientific hepatectomy / liver cirrhosis / vascular invasion / immunotherapy

References

[1] SungH, FerlayJ, SiegelRL, et al.. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin, 2021, 71(3): 209-249

[2] O’LearyC, MahlerM, SoulenMC. Curative-Intent Therapies in Localized Hepatocellular Carcinoma. Curr Treat Options Oncol, 2020, 21(4): 31

[3] BruixJ, ShermanM. Management of Hepatocellular Carcinoma. Hepatology, 2005, 42(5): 1208-1236

[4] RahbariNN, MehrabiA, MollbergNM, et al.. Hepatocellular Carcinoma: Current Management and Perspectives for the Future. Ann Surg, 2011, 253(3): 453-469

[5] SasakiK, ShindohJ, MargonisGA, et al.. Effect of Background Liver Cirrhosis on Outcomes of Hepatectomy for Hepatocellular Carcinoma. JAMA Surg, 2017, 152(3): e165059

[6] ImamuraH, MatsuyamaY, TanakaE, et al.. Risk Factors Contributing to Early and Late Phase Intrahepatic Recurrence of Hepatocellular Carcinoma After Hepatectomy. J Hepatol, 2003, 38(2): 200-207 2

[7] CucchettiA, PiscagliaF, CaturelliE, et al.. Comparison of Recurrence of Hepatocellular Carcinoma After Resection in Patients with Cirrhosis to its Occurrence in a Surveilled Cirrhotic Population. Ann Surg Oncol, 2009, 16(2): 413-422

[8] ChengZ, YangP, QuS, et al.. Risk Factors and Management for Early and Late Intrahepatic Recurrence of Solitary Hepatocellular Carcinoma After Curative Resection. HPB (Oxford), 2015, 17(5): 422-427

[9] FinnRS, QinS, IkedaM, et al.. Atezolizumab Plus Bevacizumab in Unresectable Hepatocellular Carcinoma. N Engl J Med, 2020, 382(20): 1894-1905

[10] ZhangEL, ZhangZY, LiJ, et al.. Complete Response to the Sequential Treatment with Regorafenib Followed by PD-1 Inhibitor in a Sorafenib-Refractory Hepatocellular Carcinoma Patient. Onco Targets Ther, 2020, 13: 12477-12487

[11] LongX, ZhangL, WangWQ, et al.. Response of Scalp and Skull Metastasis to Anti-PD-1 Antibody Combined with Regorafenib Treatment in a Sorafenib-Resistant Hepatocellular Carcinoma Patient and a Literature Review. Onco Targets Ther, 2022, 15: 703-716

[12] TsochatzisEA, BoschJ, BurroughsAK. Liver Cirrhosis. Lancet, 2014, 383(9930): 1749-1761

[13] de FranchisR. Evolving Consensus in Portal Hypertension. Report of the Baveno IV Consensus Workshop On Methodology of Diagnosis and Therapy in Portal Hypertension. J Hepatol, 2005, 43(1): 167-176

[14] KimMY, BaikSK, YeaCJ, et al.. Hepatic Venous Pressure Gradient Can Predict the Development of Hepatocellular Carcinoma and Hyponatremia in Decompensated Alcoholic Cirrhosis. Eur J Gastroenterol Hepatol, 2009, 21(11): 1241-1246

[15] GuJ, ZhangE, LiangB, et al.. Effectiveness Comparison of Indocyanine Green Retention Test with the Cirrhotic Severity Scoring in Evaluating the Pathological Severity of Liver Cirrhosis in Patients with Hepatocellular Carcinoma and Child-Pugh Grade A Liver Function. World J Surg Oncol, 2020, 18(1): 79 1

[16] GuJ, ZhangE, LiangB, et al.. Use of Direct Liver Stiffness Measurement in Evaluating the Severity of Liver Cirrhosis in Patients with Hepatocellular Carcinoma. World J Surg, 2020, 44(8): 2777-2783

[17] ZhouSJ, ZhangEL, LiangBY, et al.. Morphologic Severity of Cirrhosis Determines the Extent of Liver Resection in Patients with Hepatocellular Carcinoma and Child-Pugh Grade A Cirrhosis. J Surg Res, 2016, 200(2): 444-451

[18] KimMY, ChoMY, BaikSK, et al.. Histological Subclassification of Cirrhosis Using the Laennec Fibrosis Scoring System Correlates with Clinical Stage and Grade of Portal Hypertension. J Hepatol, 2011, 55(5): 1004-1009

[19] BoleslawskiE, PetrovaiG, TruantS, et al.. Hepatic Venous Pressure Gradient in the Assessment of Portal Hypertension Before Liver Resection in Patients with Cirrhosis. Br J Surg, 2012, 99(6): 855-863

[20] EASL-EORTC Clinical Practice Guidelines: Management of Hepatocellular Carcinoma. J Hepatol, 2012,56(4):908–943

[21] TangYH, ZhuWJ, WenTF. Influence of Clinically Significant Portal Hypertension On Hepatectomy for Hepatocellular Carcinoma: A Meta-Analysis. Asian Pac J Cancer Prev, 2014, 15(4): 1649-1654

[22] BerzigottiA, ReigM, AbraldesJG, et al.. Portal Hypertension and the Outcome of Surgery for Hepatocellular Carcinoma in Compensated Cirrhosis: A Systematic Review and Meta-Analysis. Hepatology, 2015, 61(2): 526-536

[23] CucchettiA, ErcolaniG, VivarelliM, et al.. Is Portal Hypertension a Contraindication to Hepatic Resection?. Ann Surg, 2009, 250(6): 922-928

[24] SantambrogioR, KlugerMD, CostaM, et al.. Hepatic Resection for Hepatocellular Carcinoma in Patients with Child-Pugh’s a Cirrhosis: Is Clinical Evidence of Portal Hypertension a Contraindication?. HPB (Oxford), 2013, 15(1): 78-84

[25] HeW, ZengQ, ZhengY, et al.. The Role of Clinically Significant Portal Hypertension in Hepatic Resection for Hepatocellular Carcinoma Patients: A Propensity Score Matching Analysis. BMC Cancer, 2015, 15: 263

[26] DongKS, LiangBY, ZhangZY, et al.. Histologic Severity of Liver Cirrhosis: A Key Factor Affecting Surgical Outcomes of Hepatocellular Carcinoma in Patients with Portal Hypertension. Asian J Surg, 2019, 42(12): 981-989

[27] ZhangEL, ZhangZY, WangSP, et al.. Predicting the Severity of Liver Cirrhosis through Clinical Parameters. J Surg Res, 2016, 204(2): 274-281

[28] IshakK, BaptistaA, BianchiL, et al.. Histological Grading and Staging of Chronic Hepatitis. J Hepatol, 1995, 22(6): 696-699

[29] BattsKP, LudwigJ. Chronic Hepatitis. An Update On Terminology and Reporting. Am J Surg Pathol, 1995, 19(12): 1409-1417

[30] BedossaP, PoynardT. An Algorithm for the Grading of Activity in Chronic Hepatitis C. The METAVIR Cooperative Study Group. Hepatology, 1996, 24(2): 289-293

[31] KutamiR, GirgrahN, WanlessIR, et al.. The Laennec grading system for assessment of hepatic fibrosis: validation by correlation with wedged hepatic vein pressure and clinical features. Hepatology, 2000, 32(42): 407A

[32] SunY, ZhouJ, WangL, et al.. New Classification of Liver Biopsy Assessment for Fibrosis in Chronic Hepatitis B Patients Before and After Treatment. Hepatology, 2017, 65(5): 1438-1450

[33] StandishRA, CholongitasE, DhillonA, et al.. An Appraisal of the Histopathological Assessment of Liver Fibrosis. Gut, 2006, 55(4): 569-578

[34] GuJ, ZhangE, LiangB, et al.. Liver Collagen Contents are Closely Associated with the Severity of Cirrhosis and Posthepatectomy Liver Failure in Patients with Hepatocellular Carcinoma and Child-Pugh Grade A Liver Function. Ann Surg Oncol, 2021, 28(8): 4227-4235

[35] FattovichG, GiustinaG, SchalmSW, et al.. Occurrence of Hepatocellular Carcinoma and Decompensation in Western European Patients with Cirrhosis Type B. The EUROHEP Study Group On Hepatitis B Virus and Cirrhosis. Hepatology, 1995, 21(1): 77-82

[36] FattovichG, StroffoliniT, ZagniI, et al.. Hepatocellular Carcinoma in Cirrhosis: Incidence and Risk Factors. Gastroenterology, 2004, 127(5Suppl1): S35-50

[37] FlemmingJA, YangJD, VittinghoffE, et al.. Risk Prediction of Hepatocellular Carcinoma in Patients with Cirrhosis: The ADRESS-HCC Risk Model. Cancer-Am Cancer Soc, 2014, 120(22): 3485-3493

[38] KimSU, OhHJ, WanlessIR, et al.. The Laennec Staging System for Histological Sub-Classification of Cirrhosis is Useful for Stratification of Prognosis in Patients with Liver Cirrhosis. J Hepatol, 2012, 57(3): 556-563

[39] JungKS, KimSU, AhnSH, et al.. Risk Assessment of Hepatitis B Virus-Related Hepatocellular Carcinoma Development Using Liver Stiffness Measurement (FibroScan). Hepatology, 2011, 53(3): 885-894

[40] TauraK, IkaiI, HatanoE, et al.. Influence of Coexisting Cirrhosis On Outcomes After Partial Hepatic Resection for Hepatocellular Carcinoma Fulfilling the Milan Criteria: An Analysis of 293 Patients. Surgery, 2007, 142(5): 685-694

[41] WangQ, FielMI, BlankS, et al.. Impact of Liver Fibrosis On Prognosis Following Liver Resection for Hepatitis B-associated Hepatocellular Carcinoma. Br J Cancer, 2013, 109(3): 573-581

[42] KadriHS, BlankS, WangQ, et al.. Outcomes Following Liver Resection and Clinical Pathologic Characteristics of Hepatocellular Carcinoma Occurring in Patients with Chronic Hepatitis B and Minimally Fibrotic Liver. Eur J Surg Oncol, 2013, 39(12): 1371-1376

[43] HuangZY, ChenG, HaoXY, et al.. Outcomes of Non-Anatomic Liver Resection for Hepatocellular Carcinoma in the Patients with Liver Cirrhosis and Analysis of Prognostic Factors. Langenbecks Arch Surg, 2011, 396(2): 193-199

[44] KimSU, JungKS, LeeS, et al.. Histological Subclassification of Cirrhosis Can Predict Recurrence After Curative Resection of Hepatocellular Carcinoma. Liver Int, 2014, 34(7): 1008-1017

[45] LiangBY, GuJ, XiongM, et al.. Histological Severity of Cirrhosis Influences Surgical Outcomes of Hepatocellular Carcinoma After Curative Hepatectomy. J Hepatocell Carcinoma, 2022, 9: 633-647

[46] ClavienPA, PetrowskyH, DeOliveiraML, et al.. Strategies for Safer Liver Surgery and Partial Liver Transplantation. N Engl J Med, 2007, 356(15): 1545-1559

[47] AdamR, BhanguiP, VibertE, et al.. Resection Or Transplantation for Early Hepatocellular Carcinoma in a Cirrhotic Liver: Does Size Define the Best Oncological Strategy?. Ann Surg, 2012, 256(6): 883-891

[48] KrenzienF, SchmelzleM, StrueckerB, et al.. Liver Transplantation and Liver Resection for Cirrhotic Patients with Hepatocellular Carcinoma: Comparison of Long-Term Survivals. J Gastrointest Surg, 2018, 22(5): 840-848

[49] KoniarisLG, LeviDM, PedrosoFE, et al.. Is Surgical Resection Superior to Transplantation in the Treatment of Hepatocellular Carcinoma?. Ann Surg, 2011, 254(3): 527-537 discussion 537–538

[50] HuangZY, LiangBY, XiongM, et al.. Severity of Cirrhosis Should Determine the Operative Modality for Patients with Early Hepatocellular Carcinoma and Compensated Liver Function. Surgery, 2016, 159(2): 621-631

[51] HanahanD, WeinbergRA. Hallmarks of Cancer: The Next Generation. Cell, 2011, 144(5): 646-674

[52] MitsunobuM, ToyosakaA, OriyamaT, et al.. Intrahepatic Metastases in Hepatocellular Carcinoma: The Role of the Portal Vein as an Efferent Vessel. Clin Exp Metastasis, 1996, 14(6): 520-529

[53] SuginoT, YamaguchiT, HoshiN, et al.. Sinusoidal Tumor Angiogenesis is a Key Component in Hepatocellular Carcinoma Metastasis. Clin Exp Metastasis, 2008, 25(7): 835-841

[54] ZhangXP, WangK, WeiXB, et al.. An Eastern Hepatobiliary Surgery Hospital Microvascular Invasion Scoring System in Predicting Prognosis of Patients with Hepatocellular Carcinoma and Microvascular Invasion After R0 Liver Resection: A Large-Scale, Multicenter Study. Oncologist, 2019, 24(12): e1476-1488

[55] CucchettiA, PiscagliaF, GrigioniAD, et al.. Preoperative Prediction of Hepatocellular Carcinoma Tumour Grade and Micro-Vascular Invasion by Means of Artificial Neural Network: A Pilot Study. J Hepatol, 2010, 52(6): 880-888

[56] Rodriguez-PeralvarezM, LuongTV, AndreanaL, et al.. A Systematic Review of Microvascular Invasion in Hepatocellular Carcinoma: Diagnostic and Prognostic Variability. Ann Surg Oncol, 2013, 20(1): 325-339

[57] LeiZ, LiJ, WuD, et al.. Nomogram for Preoperative Estimation of Microvascular Invasion Risk in Hepatitis B Virus-Related Hepatocellular Carcinoma within the Milan Criteria. JAMA Surg, 2016, 151(4): 356-363

[58] WangCC, IyerSG, LowJK, et al.. Perioperative Factors Affecting Long-Term Outcomes of 473 Consecutive Patients Undergoing Hepatectomy for Hepatocellular Carcinoma. Ann Surg Oncol, 2009, 16(7): 1832-1842

[59] ShindohJ, KobayashiY, KawamuraY, et al.. Microvascular Invasion and a Size Cutoff Value of 2 cm Predict Long-Term Oncological Outcome in Multiple Hepatocellular Carcinoma: Reappraisal of the American Joint Committee on Cancer Staging System and Validation Using the Surveillance, Epidemiology, and End-Results Database. Liver Cancer, 2020, 9(2): 156-166

[60] ParkS, ChoiS, ChoYA, et al.. Evaluation of the American Joint Committee On Cancer (AJCC) 8Th Edition Staging System for Hepatocellular Carcinoma in 1,008 Patients with Curative Resection. Cancer Res Treat, 2020, 52(4): 1145-1152

[61] PoonRT, FanST, NgIO, et al.. Significance of Resection Margin in Hepatectomy for Hepatocellular Carcinoma: A Critical Reappraisal. Ann Surg, 2000, 231(4): 544-551

[62] MoonJI, KwonCH, JohJW, et al.. Primary Versus Salvage Living Donor Liver Transplantation for Patients with Hepatocellular Carcinoma: Impact of Microvascular Invasion On Survival. Transplant Proc, 2012, 44(2): 487-493

[63] PangYY. The Brisbane 2000 Terminology of Liver Anatomy and Resections. HPB 2000; 2:333-39. HPB (Oxford), 2002, 4(2): 99-100

[64] NaginoM, DeMatteoR, LangH, et al.. Proposal of a New Comprehensive Notation for Hepatectomy: The “New World” Terminology. Ann Surg, 2021, 274(1): 1-3

[65] MakuuchiM, HasegawaH, YamazakiS. Ultrasonically Guided Subsegmentectomy. Surg Gynecol Obstet, 1985, 161(4): 346-350

[66] HasegawaK, KokudoN, ImamuraH, et al.. Prognostic Impact of Anatomic Resection for Hepatocellular Carcinoma. Ann Surg, 2005, 242(2): 252-259

[67] WakaiT, ShiraiY, SakataJ, et al.. Anatomic Resection Independently Improves Long-Term Survival in Patients with T1-T2 Hepatocellular Carcinoma. Ann Surg Oncol, 2007, 14(4): 1356-1365

[68] KobayashiA, MiyagawaS, MiwaS, et al.. Prognostic Impact of Anatomical Resection On Early and Late Intrahepatic Recurrence in Patients with Hepatocellular Carcinoma. J Hepatobiliary Pancreat Surg, 2008, 15(5): 515-521

[69] TanY, ZhangW, JiangL, et al.. Efficacy and Safety of Anatomic Resection Versus Nonanatomic Resection in Patients with Hepatocellular Carcinoma: A Systemic Review and Meta-Analysis. Plos One, 2017, 12(10): e186930

[70] MorisD, TsilimigrasDI, KostakisID, et al.. Anatomic Versus Non-Anatomic Resection for Hepatocellular Carcinoma: A Systematic Review and Meta-Analysis. Eur J Surg Oncol, 2018, 44(7): 927-938

[71] EguchiS, KanematsuT, AriiS, et al.. Comparison of the Outcomes Between an Anatomical Subsegmentectomy and a Non-Anatomical Minor Hepatectomy for Single Hepatocellular Carcinomas Based On a Japanese Nationwide Survey. Surgery, 2008, 143(4): 469-475

[72] ShindohJ, MakuuchiM, MatsuyamaY, et al.. Complete Removal of the Tumor-Bearing Portal Territory Decreases Local Tumor Recurrence and Improves Disease-Specific Survival of Patients with Hepatocellular Carcinoma. J Hepatol, 2016, 64(3): 594-600

[73] FengX, SuY, ZhengS, et al.. A Double Blinded Prospective Randomized Trial Comparing the Effect of Anatomic Versus Non-Anatomic Resection On Hepatocellular Carcinoma Recurrence. HPB (Oxford), 2017, 19(8): 667-674

[74] ZhaoH, ChenC, GuS, et al.. Anatomical Versus Non-Anatomical Resection for Solitary Hepatocellular Carcinoma without Macroscopic Vascular Invasion: A Propensity Score Matching Analysis. J Gastroenterol Hepatol, 2017, 32(4): 870-878

[75] ZhongXP, ZhangYF, MeiJ, et al.. Anatomical versus Non-Anatomical Resection for Hepatocellular Carcinoma with Microscope Vascular Invasion: A Propensity Score Matching Analysis. J Cancer, 2019, 10(17): 3950-3957

[76] HidakaM, EguchiS, OkudaK, et al.. Impact of Anatomical Resection for Hepatocellular Carcinoma with Microportal Invasion (vp1): A Multi-Institutional Study by the Kyushu Study Group of Liver Surgery. Ann Surg, 2020, 271(2): 339-346

[77] DahiyaD, WuTJ, LeeCF, et al.. Minor Versus Major Hepatic Resection for Small Hepatocellular Carcinoma (HCC) in Cirrhotic Patients: A 20-Year Experience. Surgery, 2010, 147(5): 676-685

[78] ZhangY, HuangG, WangY, et al.. Is Salvage Liver Resection Necessary for Initially Unresectable Hepatocellular Carcinoma Patients Downstaged by Transarterial Chemoembolization? Ten Years of Experience. Oncologist, 2016, 21(12): 1442-1449

[79] ZhangY, ZhangM, ChenM, et al.. Association of Sustained Response Duration with Survival After Conventional Transarterial Chemoembolization in Patients with Hepatocellular Carcinoma. JAMA Netw Open, 2018, 1(6): e183213

[80] KudoM, FinnRS, QinS, et al.. Lenvatinib Versus Sorafenib in First-Line Treatment of Patients with Unresectable Hepatocellular Carcinoma: A Randomised Phase 3 Non-Inferiority Trial. Lancet, 2018, 391(10126): 1163-1173

[81] FinnRS, IkedaM, ZhuAX, et al.. Phase Ib Study of Lenvatinib Plus Pembrolizumab in Patients with Unresectable Hepatocellular Carcinoma. J Clin Oncol, 2020, 38(26): 2960-2970

[82] XuJ, ShenJ, GuS, et al.. Camrelizumab in Combination with Apatinib in Patients with Advanced Hepatocellular Carcinoma (RESCUE): A Nonrandomized, Open-Label, Phase II Trial. Clin Cancer Res, 2021, 27(4): 1003-1011

[83] RenZ, XuJ, BaiY, et al.. Sintilimab Plus a Bevacizumab Biosimilar (IBI305) Versus Sorafenib in Unresectable Hepatocellular Carcinoma (ORIENT-32): A Randomised, Open-Label, Phase 2–3 Study. Lancet Oncol, 2021, 22(7): 977-990

[84] ZhangWW, HuBY, HanJ, et al.. Preliminary report on the study of conversion therapy of advanced hepatocellular carcinoma combined PD-1 inhibitors with multitarget tyrosine kinase inhibitors. Chin J Hepatobil Surg (Chinese), 2020, 26: 947-948

[85] HuangY, ZhangZ, ZhouY, et al.. Should we Apply Sorafenib in Hepatocellular Carcinoma Patients with Microvascular Invasion After Curative Hepatectomy?. Onco Targets Ther, 2019, 12: 541-548

[86] BruixJ, TakayamaT, MazzaferroV, et al.. Adjuvant Sorafenib for Hepatocellular Carcinoma After Resection Or Ablation (STORM): A Phase 3, Randomised, Double-Blind, Placebo-Controlled Trial. Lancet Oncol, 2015, 16(13): 1344-1354

[87] FaustoN, LairdAD, WebberEM. Liver Regeneration. 2. Role of Growth Factors and Cytokines in Hepatic Regeneration. Faseb J, 1995, 9(15): 1527-1536

[88] MichalopoulosGK, DeFrancesM. Liver Regeneration. Adv Biochem Eng Biotechnol, 2005, 93: 101-134

[89] KatoA, BambaH, ShinoharaM, et al.. Relationship Between Expression of Cyclin D1 and Impaired Liver Regeneration Observed in Fibrotic Or Cirrhotic Rats. J Gastroenterol Hepatol, 2005, 20(8): 1198-1205

[90] NagasueN, YukayaH, OgawaY, et al.. Human Liver Regeneration After Major Hepatic Resection. A Study of Normal Liver and Livers with Chronic Hepatitis and Cirrhosis. Ann Surg, 1987, 1: 30-39

[91] YamanakaN, OkamotoE, KawamuraE, et al.. Dynamics of Normal and Injured Human Liver Regeneration After Hepatectomy as Assessed On the Basis of Computed Tomography and Liver Function. Hepatology, 1993, 18(1): 79-85

[92] TauraK, IkaiI, HatanoE, et al.. Influence of Coexisting Cirrhosis On Outcomes After Partial Hepatic Resection for Hepatocellular Carcinoma Fulfilling the Milan Criteria: An Analysis of 293 Patients. Surgery, 2007, 142(5): 685-694

[93] WangQ, FielMI, BlankS, et al.. Impact of Liver Fibrosis On Prognosis Following Liver Resection for Hepatitis B-associated Hepatocellular Carcinoma. Br J Cancer, 2013, 109(3): 573-581

[94] SasakiK, ShindohJ, MargonisGA, et al.. Effect of Background Liver Cirrhosis on Outcomes of Hepatectomy for Hepatocellular Carcinoma. JAMA Surg, 2017, 152(3): e165059

[95] LeeHW, ChoiGH, KimDY, et al.. Less Fibrotic Burden Differently Affects the Long-Term Outcomes of Hepatocellular Carcinoma after Curative Resection. Oncology, 2017, 93(4): 224-232

[96] ZhangEL, LiJ, LiJ, et al.. Sub-Classification of Cirrhosis Affects Surgical Outcomes for Early Hepatocellular Carcinoma Independent of Portal Hypertension. Front Oncol, 2021, 11: 671313

[97] YamashitaY, TsuijitaE, TakeishiK, et al.. Predictors for Microinvasion of Small Hepatocellular Carcinoma ≤ 2 cm. Ann Surg Oncol, 2012, 19(6): 2027-2034

[98] MatsumotoT, KubotaK, AokiT, et al.. Clinical Impact of Anatomical Liver Resection for Hepatocellular Carcinoma with Pathologically Proven Portal Vein Invasion. World J Surg, 2016, 40(2): 402-411