Role of the width of the surgical margin in a hepatectomy for small hepatocellular carcinomas eligible for percutaneous local ablative therapy

Background There is intense clinical interest to determine whether a wide surgical margin is required to improve postoperative recurrence after locoregional therapy for small hepatocellular carcinomas (HCCs). Methods From 1996 to 2003, 117 patients with small HCCs, and also matching the criteria for local ablation therapy (up to 3 nodules ≤30 mm in size), were analyzed retrospectively to determine the prognostic factors affecting postoperative recurrence. Results The number of tumors and the surgical margin status were independent factors influencing the disease-free survival. The wide surgical margin status (≥10 mm) provided a favorable disease-free survival in the 39 patients with negative hepatitis C virus infection (P = .0020) in the 59 patients with larger tumor size (≥25 mm) (P = .0265) and in the 60 younger patients (≤63 y) (P = .0103). Conclusions A surgical margin (≥10 mm) should be secured in young patients without hepatitis C virus infection and/or a tumor size of 25 mm or larger because long-term disease-free survival could be expected after a macroscopic curative hepatectomy for small HCCs.