Postoperative outcomes in patients with hepatocellular carcinomas resected with exposure of the tumor surface: clinical role of the no-margin resection.

Hypothesis: We hypothesized that no-margin resections for hepatocellular carcinoma do not negatively affect patient outcomes.

Design: Inception cohort study.

Setting: Department of surgery at a university hospital.

Patients: From January 1992 to December 2005 at our institute, 465 consecutive patients with a preoperative diagnosis of hepatocellular carcinoma with curative potential were evaluated.

Intervention: Liver resection performed with or without surgical margins.

Main Outcome Measures: Overall survival and no-recurrence survival.

Results: Of the 465 patients, 62 underwent resections with exposure of the tumor surface at the cut stump (the cut surface of the remnant liver) with no surgical margins (exposure group), because the tumor adhered to the major hepatic vascular structures. The remaining 365 patients underwent resections without exposure of the tumor surface (nonexposure group). There were no significant differences between the 2 groups regarding the recurrence and overall survival rates. There were also no significant differences between the 2 groups with respect to the recurrence rate at the cut stump or the number and the location of intrahepatic recurrences, despite the less favorable clinical histories in the exposure group.

Conclusions: Limited resection with no margin seems to be the best procedure for patients with tumors close to the major hepatic vessels and with hepatic functions that do not permit wide-margin resections.