Significance of surgical margin width versus anatomical resection for hepatocellular carcinoma

Extensive research has examined the survival benefits of anatomical resection versus wide surgical margins in hepatocellular carcinoma (HCC). Yet how to choose between them in practice remains unsettled. We therefore investigated whether tumor size could inform this surgical decision.

We retrospectively analyzed 302 patients with HCC who underwent curative liver resection at three centers between December 2009 and December 2010. Patients were divided into two groups according to tumor diameter: ≤3 cm (n=104) and >3 cm (n=198). Baseline clinicopathologic characteristics and longterm oncologic outcomes were compared between the two groups. We also assessed how surgical margin width (≥1 cm vs. <1 cm) and anatomical resection influenced overall survival (OS) and recurrencefree survival (RFS) in each subgroup. All statistical analyses were performed using SPSS 25.0 (IBM Corp., Armonk, NY).

The effect of surgical margin width on prognosis differed based on tumor size. Among patients with tumors >3 cm, a margin ≥1 cm was associated with better OS and RFS (P<0.05) and lower rates of early recurrence. For tumors ≤3 cm, survival correlated with multiple factors-including Hepatitis B Virus Deoxyribonucleic Acid (HBV-DNA) level, serum Alpha-fetoprotein (AFP), tumor number, Tumor-Node-Metastasis (TNM) stage, tumor capsule, microvascular invasion, and vascular thrombus but not with surgical margin width.

Tumor diameter influences the choice of surgical strategy for HCC. Anatomical and nonanatomical resection yielded comparable prognosis for tumors ≤3 cm. For lesions larger than 3 cm, however, wide-margin resection offered better survival than anatomical resection alone.