Effect of Surgical Margin Width on Patterns of Recurrence among Patients Undergoing R0 Hepatectomy for T1 Hepatocellular Carcinoma: An International Multi-Institutional Analysis. Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract Tsilimigras, D. I., Sahara, K., Moris, D., Hyer, J. M., Paredes, A. Z., Bagante, F., Merath, K., Farooq, A. S., Ratti, F., Marques, H. P., Soubrane, O., Azoulay, D., Lam, V., Poultsides, G. A., Popescu, I., Alexandrescu, S., Martel, G., Guglielmi, A., Hugh, T., Aldrighetti, L., Endo, I., Pawlik, T. M. 2019


INTRODUCTION: Although a positive surgical margin is a known prognostic factor for recurrence, the optimal surgical margin width in the context of an R0 resection for early-stage hepatocellular carcinoma (HCC) is still debated. The aim of the current study was to examine the impact of wide (>1cm) versus narrow (<1cm) surgical margin status on the incidence and recurrence patterns among patients with T1 HCC undergoing an R0 hepatectomy.METHODS: Between 1998 and 2017, patients with T1 HCC who underwent R0 hepatectomy for stage T1 HCC were identified using an international multi-institutional database. Recurrence-free survival (RFS) was estimated, and recurrence patterns were examined based on whether patients had a wide versus narrow resection margins.RESULTS: Among 404 patients, median patient age was 66years (IQR: 58-73). Most patients (n=326, 80.7%) had surgical margin <1cm, while 78 (19.3%) patients had a >1cm margin. The majority of patients had early recurrences (<24months) in both margin width groups (<1cm: 70.3% vs >1cm: 85.7%, p=0.141); recurrence site was mostly intrahepatic (<1cm: 77% vs >1cm: 61.9%, p=0.169). The 1-, 3-, and 5-year RFS among patients with margin <1cm were 77%, 48.9%, and 35.3% versus 81.7%, 65.8%, and 60.7% for patients with margin >1cm, respectively (p=0.02). Among patients undergoing anatomic resection, resection margin did not impact RFS (3-year RFS: <1cm: 49.2% vs >1cm: 58.9%, p=0.169), whereas in the non-anatomic resection group, margin width >1cm was associated with a better 3-year RFS compared to margin <1cm (86.7% vs 47.3%, p=0.017). On multivariable analysis, margin >1cm remained protective against recurrence (HR=0.50, 95%CI 0.28-0.89), whereas Child-Pugh B (HR=2.13, 95%CI 1.09-4.15), AFP >20 ng/mL (HR=1.71, 95%CI 1.18-2.48), and presence of microscopic lymphovascular invasion (HR=1.48, 95%CI 1.01-2.18) were associated with a higher hazard of recurrence.CONCLUSION: Resection margins >1cm predicted better RFS among patients undergoing R0 hepatectomy for T1 HCC, especially small (<5cm) HCC. Although resection margin width did not influence outcomes after anatomic resection, wider margins were more important among patients undergoing non-anatomic liver resections.

View details for DOI 10.1007/s11605-019-04275-0

View details for PubMedID 31243714