Hepatectomy for large hepatocellular carcinoma: the optimal resection margin

Area of Science:

• Hepatobiliary Surgery
• Surgical Oncology
• Gastroenterology

Background:

• The optimal resection margin (RM) for curative hepatectomy in hepatocellular carcinoma (HCC) is not well-defined.
• Complete tumor extirpation is critical for improving survival outcomes in HCC patients.

Purpose of the Study:

• To retrospectively determine the macroscopic RM distance required for histological disease clearance in patients with large HCC (≥5 cm).
• To identify pathological predictors of positive histological margins and assess the impact of RM on survival.

Main Methods:

• Retrospective analysis of 96 patients who underwent complete macroscopic extirpation of large HCC (≥5 cm).
• Evaluation of macroscopic RM distance and correlation with histological margin status.
• Assessment of 15 pathological parameters, including microsatellites and tumor nodules, for association with positive margins.

Main Results:

• Positive histological RM occurred in 32.3% of patients, significantly compromising disease-free and overall survival.
• A 0.5 cm macroscopic RM significantly reduced residual histological disease (p<0.05), with no additional benefit from larger margins.
• Microsatellites and multiple tumor nodules were associated with an increased risk of positive histological margins.

Conclusions:

• Histological confirmation is the definitive method for assessing complete tumor clearance, as macroscopic RM measurement is unreliable.
• A 0.5 cm RM should be secured whenever anatomically feasible, particularly for multinodular HCC, to optimize surgical outcomes.
• Aggressive surgical resection for large HCC is recommended if a 0.5 cm margin can be achieved safely.