Anatomic vs. non-anatomic liver resection for hepatocellular carcinoma: standard of care or unfilled promises?

Hepatocellular carcinoma (HCC) is one of the leading causes of cancer-related death not only in the United States but in the world. One of the curative treatment options for early-stage HCC is surgical resection, which can be divided into two approaches: anatomic and nonanatomic. The theoretical advantage of anatomic liver resection is excising the entire primary tumor along with adjacent liver parenchyma containing micrometastases that reside in the surrounding portal tributaries. However, the superiority of anatomic vs. nonanatomic liver resection in patients with HCC is controversial. While this is a feasible strategy for patients with preserved liver function, it may not be ideal for patients with cirrhosis, who rely on parenchymal-sparing or nonanatomic approaches to maximize their future liver remnant and prevent post-operative liver failure. This review identifies and critically analyzes the evidence for anatomic vs. nonanatomic liver resection for HCC.