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Postoperative Outcomes in Patients With Hepatocellular Carcinomas Resected With Exposure of the Tumor Surface—Invited Critique
Jeffrey B. Matthews, MD
Arch Surg. 2007;142(7):603.
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The optimal resection margin for HCC remains controversial yet has important implications for selection of surgical candidates and operative planning. This large retrospective series from Kansai Medical University compared procedures in which tumors were peeled from underlying major vascular structures (leaving essentially no margin and an exposed tumor surface) with procedures in which a more substantial margin was obtained. The finding that overall survival and the pattern of recurrence (including at the cut surface) was not adversely affected reinforces the greater importance that factors such as tumor biology, multifocality, cirrhosis, and medical comorbidities play in determining outcomes rather than resection margin per se. Current practice has shifted away from formal anatomic resection, instead emphasizing conservation and maximization of residual functional liver tissue. Margins even smaller than 1 cm may well be acceptable, though convincing clinical data one way or the other are lacking. Among the questions . . . [Full Text of this Article]
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Yoichi Matsui, Naoyoshi Terakawa, Sohei Satoi, Masaki Kaibori, Hiroaki Kitade, Soichiro Takai, A-Hon Kwon, and Yasuo Kamiyama
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