Long term outcome of patients with close resection margin after hepatectomy for HCC: a propensity score analysis at a single centre

Abstract

Introduction: Traditionally, hepatectomy was recommended only if 10mm margin can be achieved. We analyzed the long term outcome of those with close resection margin after hepatectomy for HCC. Methods: From 1989-2017, 1793 patients underwent resection of HCC at Queen Mary Hospital, Hong Kong. 1697 patients (94.6%) achieved R0 resection. 216 (12.7%), 838 (49.4%) and 605 (35.7%) patients had resection margin 0.5-2mm, >2-10mm and >10mm respectively. The outcomes of those with close margin (0.5-2mm) (CM group) were compared with those with wide margin (>10mm) (WM group) using propensity score matching in terms of tumour size, number and differentiation in a ratio of 1:2. Result: After matching, there were 211 patients in the CM group and 422 patients in the WM group. The demographic data was comparable between the 2 group as shown in table 1 except CM group had significantly more blood loss (800ml vs 600ml, p= 0.007). The 1-year, 3-year, 5-year and 10-year overall survival was 91.5%, 72.8%, 59.8% and 43.5% for the CM group and 89.3%, 71.7% , 58.8% and 44.4% for the WM group, respectively (P=0.759) [Figure 1]. The 1-year, 3-year, 5-year and 10-year disease free survival was 64.9%, 46.1%, 37% and 27.1% for the CM group and 62.1%, 415.2%, 39.3% and 30.8% for the WM group, respectively (P=0.702). Conclusion: Surgeons should always aim for wide negative margin. However, resection of HCC with close margin could still achieve good long term survival and, thus, resection should not be excluded from those anticipated to have close resection margin.