• Pinghua Yang, Anfeng Si, Jue Yang, Zhangjun Cheng, Kui Wang, Jun Li, Yong Xia, Baohua Zhang, Timothy M Pawlik, Wan Yee Lau, and Feng Shen.
• Department of Hepatic Surgery IV, the Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China; Department of Minimally Invasive Surgery, the Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China.
• Surgery. 2019 Apr 1; 165 (4): 721-730.

BackgroundThe impact of the resection margin on survival outcomes in patients with hepatocellular carcinoma remains to be determined. This study aimed to examine the association between the width of resection margin and the presence of microvascular invasion in hepatitis B virus-related hepatocellular carcinoma.MethodsWe reviewed data on 2,508 consecutive patients who underwent liver resection for a solitary, hepatitis B virus-related hepatocellular carcinoma for operative morbidity, tumor recurrence, and overall survival.ResultsMicrovascular invasion was identified histologically in 929 patients (37.0%). A wide margin of resection (≥1 cm, n = 384) resulted in better 5-year recurrence and overall survival versus a narrow margin of resection (<1 cm, n = 545) among patients with microvascular invasion (71.1% versus 85.9%; 44.9% versus 25.0%; both P < .001), but not in patients without microvascular invasion (P = .131, .182). Similar results were identified after propensity-score matching. A wide margin resection also had a lesser incidence of early recurrence developed within the first postoperative 24 months (58.1% versus 72.7%; P < .001). Compared with a wide resection margin, a narrow margin was associated with worse recurrence and overall survival in patients with microvascular invasion (hazard ratio: 1.50 and 1.75). In addition, a wide or a narrow resection margin had differences in the rate of grade I-III, but not grade IV complications (31.0% versus 21.7%; P = .017; 3.5% versus 1.6%; P = .147) among cirrhotic patients with microvascular invasion.ConclusionThe presence of microvascular invasion was associated with a worse prognosis after resection. A wide resection margin resulted in better long-term prognoses versus a narrow resection margin among patients with hepatitis B virus-related hepatocellular carcinoma with microvascular invasion.Copyright © 2018. Published by Elsevier Inc.

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