Ideal Surgical Margin to Prevent Early Recurrence After Hepatic Resection for Hepatocellular Carcinoma

Abstract Backgrounds and Aims Postoperative early recurrence after hepatic resection for hepatocellular carcinoma (HCC) poses a challenge to surgeons, and the effect of a surgical margin is still controversial. This study aimed to identify an ideal margin to prevent early recurrence. Methods A total of 226 consecutive patients who underwent primary curative hepatic resection for solitary and primary HCC were enrolled. The definition of early recurrence was determined using the minimum P value approach. Logistic regression analysis was used to identify the risk factors of early recurrence. The receiver‐operating characteristic (ROC) curve was used to identify the optimal cut‐off of the surgical margin and early recurrence. Results Recurrence within 8 months induced the poorest overall survival ( P = 2×10 −15 ). ROC analysis showed that the optimal cut‐off value of the surgical margin was 7 mm. The risk factors of early recurrence (≤ 8‐month recurrence) were preoperative alpha‐fetoprotein levels ≥ 100 ng/ml (Odds ratio [OR] 4.92 [2.28–10.77], P < 0.0001) and a surgical margin < 7 mm (OR 3.09 [1.26–8.85], P = 0.01) by multivariable analysis. The probability of early recurrence ranged from 5.0% in the absence of any factors to 43.5% in the presence of both factors. Among patients with alpha‐fetoprotein levels ≥ 100 ng/ml, non‐capsule formation, or microvascular invasion, there was a significant difference in 5‐year overall survival between surgical margins of < 7 mm and ≥ 7 mm. Conclusions A > 7‐mm margin is important to prevent early recurrence. Patients with HCC and alpha‐fetoprotein levels > 100 ng/ml, non‐capsule formation, or microvascular invasion may have a survival benefit from a ≥ 7‐mm margin.