The Comparison of Surgical Margins and Type of Hepatic Resection for Hepatocellular Carcinoma With Microvascular Invasion

Abstract

Objective The objective of this study was to investigate the impact of surgical margin and hepatic resection on prognosis and compare their importance on prognosis in patients with hepatocellular carcinoma (HCC). Methods The clinical data of 906 patients with HCC who underwent hepatic resection in our hospital from January 2013 to January 2015 were collected retrospectively. All patients were divided into anatomical resection (AR) (n = 234) and nonanatomical resection (NAR) group (n = 672) according to type of hepatic resection. The effects of AR and NAR and wide and narrow margins on overall survival (OS) and time to recurrence (TTR) were analyzed. Results In all patients, narrow margin (1.560, 1.278-1.904; 1.387, 1.174-1.639) is an independent risk factor for OS and TTR, and NAR is not. Subgroup analysis showed that narrow margins (2.307, 1.699-3.132; 1.884, 1.439-2.468), and NAR (1.481, 1.047-2.095; 1.372, 1.012-1.860) are independent risk factors for OS and TTR in patients with microvascular invasion (MVI)-positive. Further analysis showed that for patients with MVI-positive HCC, NAR with wide margins was a protective factor for OS and TTR compared to AR with narrow margins (0.618, 0.396-0.965; 0.662, 0.448-0.978). The 1, 3, and 5 years OS and TTR rate of the two group were 81%, 49%, 29% versus 89%, 64%, 49% (P = .008) and 42%, 79%, 89% versus 32%, 58%, 74% (P = .024), respectively. Conclusions For patients with MVI-positive HCC, AR and wide margins were protective factors for prognosis. However, wide margins are more important than AR on prognosis. In the clinical setting, if the wide margins and AR cannot be ensured at the same time, the wide margins should be ensured first.

A Grading System of Microvascular Invasion for Patients with Hepatocellular Carcinoma Undergoing Liver Resection with Curative Intent: A Multicenter Study

“… 35 Thus, MVI has become an important factor in considering additional intervention in HCC patients, and identification of MVI should become increasingly important in the regular pathologic evaluation of HCC. Nevertheless, with advocacy of wide margin resection and anatomical hepatectomy, 36 , 37 antiviral therapy was able to achieve good clinical outcomes for many HCC patients after R0 resection who were found to have MVIs, 38 especially for those who had a small amount and range of MVIs. Furthermore, some adjuvant procedures could not improve survival outcomes in some patients with MVI, and could cause obvious hepatic dysfunctions.…”

Bi-regional dynamic contrast-enhanced MRI for prediction of microvascular invasion in solitary BCLC stage A hepatocellular carcinoma

“…MVI was revealed to be an independent predictor of prognosis in BCLC stage A HCC patients but exhibited limited predictive efficiency for individuals with BCLC stages 0 and/or B HCCs [ 9 , 10 ]. In patients with MVI-positive (MP) HCC, anatomical resection (AR) and wide surgical margins were protective factors for prognosis [ 11 , 12 ]. In addition, postoperative adjuvant therapy might be potentially beneficial for survival outcomes in patients with concomitant MVI [ 13 ].…”