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Clinical Role of the No-Margin Resection

Yoichi Matsui, MD; Naoyoshi Terakawa, MD; Sohei Satoi, MD; Masaki Kaibori, MD; Hiroaki Kitade, MD; Soichiro Takai, MD; A-Hon Kwon, MD; Yasuo Kamiyama, MD

Arch Surg. 2007;142(7):596-602.

Hypothesis  We hypothesized that no-margin resections for hepatocellular carcinoma do not negatively affect patient outcomes.

Design  Inception cohort study.

Setting  Department of surgery at a university hospital.

Patients  From January 1992 to December 2005 at our institute, 465 consecutive patients with a preoperative diagnosis of hepatocellular carcinoma with curative potential were evaluated.

Intervention  Liver resection performed with or without surgical margins.

Main Outcome Measures  Overall survival and no-recurrence survival.

Results  Of the 465 patients, 62 underwent resections with exposure of the tumor surface at the cut stump (the cut surface of the remnant liver) with no surgical margins (exposure group), because the tumor adhered to the major hepatic vascular structures. The remaining 365 patients underwent resections without exposure of the tumor surface (nonexposure group). There were no significant differences between the 2 groups regarding the recurrence and overall survival rates. There were also no significant differences between the 2 groups with respect to the recurrence rate at the cut stump or the number and the location of intrahepatic recurrences, despite the less favorable clinical histories in the exposure group.

Conclusions  Limited resection with no margin seems to be the best procedure for patients with tumors close to the major hepatic vessels and with hepatic functions that do not permit wide-margin resections.

Author Affiliations: Department of Surgery, Kansai Medical University, Osaka, Japan.

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Postoperative Outcomes in Patients With Hepatocellular Carcinomas Resected With Exposure of the Tumor Surface—Invited Critique
Jeffrey B. Matthews
Arch Surg. 2007;142(7):603.
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