Anatomical Resection But Not Surgical Margin Width Influence Survival Following Resection for HCC, A Propensity Score Analysis

Jung‐Woo Lee, Young‐Joo Lee, Kwang‐Min Park, Dae‐Wook Hwang, Jae Hoon Lee, Ki Byung Song

The effects of the surgical resection margin on the clinical outcomes in hepatocellular carcinoma (HCC) cases remain controversial. The objective of this study was to further examine this issue. The details of all HCC patients who underwent hepatectomy between December 1999 and December 2009 at the Division of Hepatobiliary and Pancreas Surgery, Asan Medical Center were analyzed retrospectively. We divided 1022 HCC patients into two groups according to the most significant surgical margin length. To overcome any bias due to differences in the distribution of covariates between the two groups, the patients were in a matched 1:1 ratio by propensity score analysis. A surgical margin ≤1 mm was identified as the most significant surgical margin in both disease-free survival (DFS) and overall survival (OS) (p = 0.008 and p = 0.026, respectively). However, many clinicopathological factors were different between the resection margin ≤1 mm and >1 mm groups. To reduce these different clinicopathological factors, propensity score matching was performed using 21 selected factors. After matching, no significant difference was found in DFS and OS between the two groups (p = 0.688, p = 0.398). In addition, there was no significant difference in the intrahepatic recurrence rate and pattern between the resection margin groups. Except for the preoperative patient's status and tumor stage, significant risk factors in OS were anatomical resection and postoperative morbidity (p = 0.002, p = 0.001). We identified that the widths of the resection margin in resectable hepatocellular carcinoma did not influence the postoperative recurrence rates, overall survival, and recurrence pattern in multivariable analysis as well as propensity score match analysis.