Resection margin in hepatectomy for hepatocellular carcinoma: a systematic review.

Background/aims: To evaluate the influence of the width of resection margin on recurrence and survival for hepatocellular carcinoma.

Methodology: Randomized controlled trials and non-randomized trials evaluating the influence of the width of resection margin for HCC were identified using a predefined search strategy. A meta-analysis was performed to estimate pooled recurrence and survival rate.

Results: One randomized controlled trial and four non-randomized trials were identified. The only randomized controlled trial reported that a margin aiming at 2cm could decrease the recurrence rate (p=0.037) and increase the 3-year survival (p=0.02) and 5-year survival rate (p<0.01) compared with a margin aiming at 1cm. Meta-analysis showed that there was no significant difference between the group with resection margin <1cm and the group with resection margin ≥1cm in recurrence rate (p=0.08), 1-year survival (p=0.75), 3-year survival (p=0.53) and 5-year survival rate (p=0.15).

Conclusions: A resection margin ≥1cm does not provide significant prognostic benefit compared with a resection margin <1cm. There is limited evidence to show that patients with a resection margin aiming at 2cm have better survival outcome than patients with a resection margin aiming at 1cm.