Effect of surgical margin in R0 hepatectomy on recurrence-free survival of patients with solitary hepatocellular carcinomas without macroscopic vascular invasion

The study aimed to investigate the impact of different surgical margins on recurrence-free survival (RFS) of patients with solitary hepatocellular carcinoma (HCC) without macroscopic vascular invasion. The data of 586 selected patients who underwent curative hepatectomy for HCC between 2001 and 2012 were analyzed. The patients were divided into the anatomic resection and the nonanatomic resection groups according to the surgical approaches. Each group was further divided into group A (surgical margin <5 mm), group B (5 mm <= surgical margin < 10 mm), and group C (surgical margin >= 10 mm). Relationship between surgical margins and RFS in different groups was established by receiver operating characteristic curve and Kaplan-Meier analyses. The RFS of the anatomic resection group was significantly longer than that of the nonanatomic resection group (P=0.026). There were no statistical differences in RFS between groups A, B, and C (P-AVSB=0.512, P-AVSC=0.272, P-BVSC=0.822, n(A)=38, n(B)=43, n(C)=80) in the anatomic resection group while in the nonanatomic resection group, RFSs of groups B and C were longer than that of group A (P-AVSB=0.009, P-AVSC=0.000, P-BVSC=0.505, n(A)=151, n(B)=119, n(C)=155). The analytic results suggest that if the patients with solitary HCC without macroscopic vascular invasion fall in the anatomic resection group, a minimal surgical margin (>= 0 mm) is probably appropriate for hepatectomy; however, in cases of the nonanatomic resection, a surgical margin >= 5 mm should be regarded suitable for surgery of HCC.