Is wider surgical margin justified for better clinical outcomes in patients with resectable hepatocellular carcinoma?

Background/Purpose: Surgical resection for hepatocellular carcinoma (HCC) is regarded as a, curable treatment; however, the postoperative recurrence still poses a challenge to surgeons. The effect of surgical margin on long-term outcome is still controversial, although it has been considered as the treatment-related risk factor for recurrence. A precise assessment of the effects of surgical margin on clinical outcome is required to clarify the issue. Methods: A retrospective study was conducted on 407 patients with microscopically complete resection of HCC; they were divided into three groups with surgical margin negative by 1-5 mm (Group A, n = 156), 6-10 mm (Group B, n = 109), and wider than 10 mm (Group C, n = 142). The groups were compared for clinicopathologic characteristics, perioperative features, postoperative recurrence, and long-term outcome. Results: The median follow-up time for all patients was 72.97 months. Recurrence rates were similar among these groups. There was no significant difference in the overall 1-, 3-, and 5-year actual survival rates for the groups on the log-rank test (p = 0.073). After controlling the independent risks for disease-free survival, there was also no significant difference in the 1-, 3-, and 5-year disease-free survival rates for the groups (p = 0.354). The patients with wider surgical margin had worse perioperative outcomes; more patients in this group needed blood transfusion (p < 0.001) and more patients suffered from postoperative complications (p = 0.020). They also had higher in-hospital mortality rate than that of other groups (1.41% vs. 0.64%). Conclusion: No superiority was seen in patients with wider surgical margin in either perioperative features or long-term outcome. Copyright (C) 2012, Elsevier Taiwan LLC & Formosan Medical Association. AR rights reserved.