The prognostic significance of surgical margin in liver resection of patients with hepatocellular carcinoma
S. Masutani, Y. Sasaki, S. Imaoka, S. Iwamoto, I. Ohashi, M. Kameyama, T. Kabuto, O. Ishikawa, H. Furukawa, H. Koyama and al. et
Department of Surgery, Center for Adult Diseases, Osaka, Japan.
OBJECTIVE: To evaluate the prognostic significance of surgical margin in
liver resection of patients with hepatocellular carcinoma. DESIGN:
Retrospective study. SETTING: The Center for Adult Diseases, Osaka, Japan,
between 1980 and 1989. PATIENTS: One hundred eighty-five patients with
hepatocellular carcinoma who underwent liver resection with complete
extirpation. MAIN OUTCOME MEASURE: Cumulative survival rate. RESULTS: The
patients were divided into a wide surgical margin group, in which the
lesion was excised with a margin of 1.0 cm or more, and a narrow surgical
margin group, in which the margin was less than 1.0 cm. No significant
differences could be detected in survival rates for 3 years or longer. Mean
+/- SE tumor sizes were 3.4 +/- 0.4 cm and 4.4 +/- 0.3 cm, respectively, in
the wide and narrow surgical margin groups. The patients were divided into
three groups according to tumor size: group 1, 2.0 cm or less in diameter;
group 2, greater than 2.0 cm but 5.0 cm or less in diameter; and group 3,
greater than 5.0 cm in diameter. In groups 2 and 3, no significant
differences in survival rates were found between the wide and narrow
surgical margin groups. In group 1, the survival rate was significantly
higher in the wide surgical margin group than in the narrow surgical margin
group (P < .05). CONCLUSIONS: Small hepatocellular carcinomas of 2.0 cm
or less in diameter should be resected with an adequate surgical margin.
However, surgical margin was not a significant factor in the resection of
hepatocellular carcinomas larger than 2.0 cm.
