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

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Journal of Gastrointestinal Surgery Aims and scope

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.

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Abbreviations

AUC:

Area under the curve

CI:

Confidence interval

HBV:

Hepatitis B virus

HCC:

Hepatocellular carcinoma

HCV:

Hepatitis C virus

HR:

Hazard ratio

INR:

International normalized ratio

IQR:

Interquartile range

LOS:

Length of hospital stay

LSRFS:

Liver-specific recurrence-free survival

MELD:

Model for end-stage liver disease

MVI:

Microvascular invasion

NR:

Not reached

OS:

Overall survival

RFS:

Recurrence-free survival

ROC:

Receiver operating characteristic

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Funding

This work was conducted with support from Harvard Catalyst | The Harvard Clinical and Translational Science Center (National Center for Research Resources and the National Center for Advancing Translational Sciences, National Institutes of Health Award UL1 TR001102) and financial contributions from Harvard University and its affiliated academic healthcare centers. The content is solely the responsibility of the authors and does not necessarily represent the official views of Harvard Catalyst, Harvard University, and its affiliated academic healthcare centers, or the National Institutes of Health.

Lei Cai received funding from the National Natural Science Foundation of China (#81201948), the China Scholarship Council Foundation (#201203170045), and the Natural Science Foundation of Chongqing (#cstc2012jjA0337).

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Author notes

  1. Theodoros Michelakos and Filippos Kontos contributed equally to this work.

Authors and Affiliations

  1. Department of Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA

    Theodoros Michelakos, Filippos Kontos, Yurie Sekigami, Motaz Qadan, Lei Cai, 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

  2. Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA

    Onofrio Catalano

  3. Department of Pathology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA

    Vikram Deshpande

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  1. Theodoros Michelakos
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Michelakos, T., Kontos, F., Sekigami, Y. et al. Hepatectomy for Solitary Hepatocellular Carcinoma: Resection Margin Width Does Not Predict Survival. J Gastrointest Surg 25, 1727–1735 (2021). https://doi.org/10.1007/s11605-020-04765-6

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