title: Is wider surgical margin justified for better clinical outcomes in patients with resectable hepatocellular carcinoma?
abstract: OBJECTIVE
  Surgical resection for hepatocellular carcinoma (HCC) is regarded as a curable treatment; however, the postoperative recurrence still poses a challenge to surgeons. The effect of surgical margin on long-term outcome is still controversial, although it has been considered as the treatment-related risk factor for recurrence. A precise assessment of the effects of surgical margin on clinical outcome is required to clarify the issue.
  
  
  METHODS
  A retrospective study was conducted on 407 patients with microscopically complete resection of HCC; they were divided into three groups with surgical margin negative by 1-5 mm (Group A, n = 156), 6-10 mm (Group B, n = 109), and wider than 10 mm (Group C, n = 142). The groups were compared for clinicopathologic characteristics, perioperative features, postoperative recurrence, and long-term outcome.
  
  
  RESULTS
  The median follow-up time for all patients was 72.97 months. Recurrence rates were similar among these groups. There was no significant difference in the overall 1-, 3-, and 5-year actual survival rates for the groups on the log-rank test (p = 0.073). After controlling the independent risks for disease-free survival, there was also no significant difference in the 1-, 3-, and 5-year disease-free survival rates for the groups (p = 0.354). The patients with wider surgical margin had worse perioperative outcomes; more patients in this group needed blood transfusion (p < 0.001) and more patients suffered from postoperative complications (p = 0.020). They also had higher in-hospital mortality rate than that of other groups (1.41% vs. 0.64%).
  
  
  CONCLUSIONS
  No superiority was seen in patients with wider surgical margin in either perioperative features or long-term outcome.
authors.affiliation: Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
authors.forename: King-Teh
authors.initials: KT
authors.lastname: Lee
authors.forename: Shen-Nien
authors.initials: SN
authors.lastname: Wang
authors.forename: Rong-Wei
authors.initials: RW
authors.lastname: Su
authors.forename: Hong-Yaw
authors.initials: HY
authors.lastname: Chen
authors.forename: Hon-Yi
authors.initials: HY
authors.lastname: Shi
authors.forename: Chen-Go
authors.initials: CG
authors.lastname: Ker
authors.forename: Herng-Chia
authors.initials: HC
authors.lastname: Chiu
mesh_terms: D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000209:etiology*; D016016:Proportional Hazards Models; D013997:Time Factors; D016896:Treatment Outcome