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