Hepatectomy for Solitary Hepatocellular Carcinoma: Resection Margin Width Does Not Predict Survival

Theodoros Michelakos, Filippos Kontos, Yurie Sekigami, Motaz Qadan, Lei Cai, Onofrio Catalano, Vikram Deshpande, Madhukar S. Patel, Teppei Yamada, Nahel Elias, Leigh Anne Dageforde, Shoko Kimura, Tatsuo Kawai, Kenneth K. Tanabe, James F. Markmann, Heidi Yeh, Cristina R. Ferrone

Research output: Contribution to journalArticlepeer-review

5 Scopus citations

Abstract

Background: The survival benefit of negative margins for hepatocellular carcinoma (HCC) has been demonstrated. However, there is no consensus regarding the optimal resection margin width. We assessed the impact of hepatic resection margin width for solitary HCC on overall (OS), recurrence-free (RFS), and liver-specific recurrence-free survival (LSRFS). Methods: Clinicopathologic data were retrospectively collected for solitary HCC patients who underwent a negative margin hepatectomy (1992–2015). Margin width was categorized in tertiles as “narrow” (≤ 0.3 cm), “intermediate” (0.31–1.0 cm), or “wide” (> 1.0 cm). Survival was compared among groups. Results: Of the 178 included patients, most were male (76%); median age, MELD score, and tumor size were 63 years, 8, and 5.2 cm, respectively; 93% were Child-Pugh class A. Median margin width was 0.5 cm. Median follow-up and OS were 47.8 months and 76.7 months, respectively. There was no significant survival difference among narrow, intermediate, and wide margin groups with a median OS of 53 months (IQR 21–not reached [NR]), 74 months (IQR 14–138), and 97 months (IQR 37–142) (p = 0.87), respectively. Median RFS was 33.0 months; again, there was no difference among narrow, intermediate, and wide margin groups with a median of 31 months (IQR 18–NR), 45 months (IQR 14–NR), and 27 months (IQR 11–NR), respectively (p = 0.66). Median LSRFS was 63.0 months (IQR 14–NR) with no difference among groups (p = 0.87). In multivariate analyses, margin width was not associated with OS (p = 0.77), RFS (p = 0.74), or LSRFS (p = 0.92). Findings were similar in all subgroups analyzed (≤ 5 cm, > 5 cm, microvascular invasion, T1, T2/T3, anatomical or non-anatomical resection, major or minor hepatectomy). Conclusions: Narrow margins appear to be oncologically safe and the feasibility of achieving wide margins should not determine resectability.

Original languageEnglish (US)
Pages (from-to)1727-1735
Number of pages9
JournalJournal of Gastrointestinal Surgery
Volume25
Issue number7
DOIs
StatePublished - Jul 2021
Externally publishedYes

Keywords

  • Hepatectomy
  • Hepatocellular carcinoma
  • Margin
  • Survival

ASJC Scopus subject areas

  • Surgery
  • Gastroenterology

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