Prognostic Impact of Surgical Margin in Hepatectomy on Patients With Hepatocellular Carcinoma: A Meta-Analysis of Observational Studies

Abstract

ObjectiveThis study aims to comprehensively evaluate the prognostic impact of the surgical margin in hepatectomy on patients diagnosed with hepatocellular carcinoma (HCC).MethodsA comprehensive and systematic search for eligible articles published in English before July 2021 was conducted across PubMed, Cochrane Library, Web of Science, and Embase electronic databases. The overall survival (OS) and disease-free survival (DFS) were the primary endpoints.ResultsIn total, 37 observational studies with 12,295 cases were included in this meta-analysis. The results revealed that a wide surgical margin (≥1 cm) was associated with better OS (hazard ration (HR), 0.70; 95% confidence interval (CI), 0.63–0.77) and DFS (HR, 0.66; 95% CI, 0.61–0.71) compared to a narrow surgical margin (<1 cm). Subgroup analyses were conducted based on median follow-up time, gender, country, hepatitis B surface antigen (HBsAg) status, tumor number, and liver cirrhosis. The prognostic benefit of a wide surgical margin was consistent in most subgroups, however, analysis of studies from Western countries showed that margin width was not associated with prognosis.ConclusionIn summary, a surgical margin wider than 1 cm prolongs the long-term prognosis of HCC patients compared to a surgical margin narrower than 1 cm.

Does Using Indocyanine Green Fluorescence Imaging for Tumors Help in Determining the Safe Surgical Margin in Real-Time Navigation of Laparoscopic Hepatectomy? A Retrospective Study

“…Due to the specific biological behaviors of HCC, such as its susceptibility to microvascular invasion, the status of the HCC resection margin is an established prognostic factor and most authors suggest a wide-margin ([ 7-10 mm) hepatectomy for HCC. [23][24][25] The Chinese Guidelines for the Diagnosis and Treatment of Primary Liver Cancer also suggest that the surgical margin for HCC should be greater than 10 mm away from the tumor boundary. 26 Recent studies have shown that the use of ICG fluorescent staining of hepatic lesions may help ensure negative surgical margins.…”

Reply

“…Regarding surgical margins, a recent meta‐analysis found that margin width was associated with prognosis in Eastern but not Western countries. [ 2 ] Notwithstanding the relevance of specific risk factors not included in the analysis, we recognize that the sample size of our study limits accommodation of an increasingly large number of variables in the models without compromising stability. In order to address this, we encourage well‐designed multicenter studies with clearly defined variables and endpoints.…”