Narrow-Margin Hepatectomy Resulted in Higher Recurrence and Lower Overall Survival for R0 Resection Hepatocellular Carcinoma

Abstract

PurposeTo evaluate the impact of resection margin on recurrence pattern and survival for hepatocellular carcinoma (HCC) with narrow margin resection, with the aim to guide postoperative treatment.Materials and MethodsTwo hundred forty HCC patients after curative hepatectomy between 2014 and 2016 were reviewed retrospectively. The cases were divided into narrow-margin (width of resection margin <1cm, n=106) and wide-margin (width of resection margin ≥1cm, n=134) groups based on the width of resection margin. Recurrence pattern, recurrence-free survival (RFS), and overall survival (OS) were compared between the above two groups. An additional cohort of nine cases with positive margin plus post-operative stereotactic body radiotherapy (SBRT) was also analyzed for the recurrence pattern.ResultsPostoperative recurrence was found in 128 (53.3%) patients. The recurrence rate was significantly higher in narrow-margin group than that in wide-margin group (P=0.001), especially for the pattern of marginal recurrence (20.8 vs. 4.5%, P=0.003). The 1-, 2-, 3-year RFS rates for the narrow-margin and wide-margin groups were 55.8, 43.9, 36.9, and 78.7, 67.9, 60.2%, respectively, with significant difference between the two groups (P<0.001). Patients with narrow margin showed a tendency of decreased OS than those with wide margin (P<0.001). As comparison, the nine cases with positive margin treated with postoperative SBRT showed low recurrence rate and no marginal recurrence was found.ConclusionPatients with narrow resection margin were associated with higher recurrence rate and worse survival than those with wide resection margin. These patients may benefit from adjuvant local treatment, such as radiotherapy.

The role of postoperative radiotherapy in hepatocellular carcinoma

“…Regarding surgical margins, a worse prognosis has been reported for less than 1.0 cm (10,11), and it is frequently associated with marginal recurrence (12,13). This notion agrees with the necessity of postoperative RT, which is in accordance with the results of this study (9).…”

Systematic review of adjuvant external beam radiotherapy for hepatocellular carcinoma following radical hepatectomy

“…Narrow margin is also one of the most important risk factors for recurrence and adverse prognosis [36,37], although the optimal margin distance is still not clear. With the advances in surgical technique, increasingly complex hepatectomy including mesohepatectomy are being carried out worldwide [4].…”

Oncological outcomes of anatomic versus non-anatomic resections for small hepatocellular carcinoma: systematic review and meta-analysis of propensity-score matched studies

“…Most intrahepatic recurrences were considered to arise from intrahepatic metastasis by venous dissemination, which a wide resection margin could not prevent. However, recent studies [37][38][39][40][41] suggest that HCC patients with narrow resection margin were associated with a higher tumor recurrence rate and a shorter DFS. A multicenter retrospective study [42] concluded that AR with a negative 0-mm surgical margin may be acceptable in patients with a single hepatocellular carcinoma.…”