| Hepatocellular carcinoma(HCC)is the second leading cause of cancer related to mortality worldwide.Liver resection is still the first line treatment in well-selected patients with HCC,however,most patients undergo an extremely poor survival time because of high tumor recurrence rate.Therefore,founding efficacious treatments of decreasing tumor recurrence is an significant work to treat HCC patients.Except for liver transplantation,re-hepatectomy is still the most effective method to cure HCC.However,for several reasons,re-hepatectomy calls for more strict demands of status of patients,as well as surgical techniques.In liver resection for primary HCC,a wide surgical margin has been reported to be more effective in improving postoperative prognosis than a narrow one in some studies.However,it is worth mentioning that a wide surgical margin cannot be commonly achieved in recurrent HCC patients,as remnant liver volume may be insufficient and reserved liver function is decreased due to initial hepatectomy.Therefore,it seems that the determination of appropriate surgical margin in re-hepatectomy is more crucial and more difficult than that in initial resection.The presence of microvascular invasion(MVI)has been proven to increase the risk of tumor recurrence and deteriorate long-term survival after either initial or repeat liver resection for HCC.Moreover,a wide surgical margin is shown to be associated with decrease tumor recurrence in patients with initial HCC with histopathological MVI.In consequence,it is still under investigation that whether MVI status and surgical marginhave double impacts on prognosis of HCC.As there are several difficulties in selection of surgical margin in re-hepatectomy,we designed the following research to explore.Background & aims: Repeat hepatectomy(re-hepatectomy)is an effective treatment for recurrent hepatocellular carcinoma(re-HCC).This study aimed to evaluate the impact of surgical margin of re-hepatectomy on the short-and long-term prognoses.Methods: Data of 327 patients who had ≤ 200 points according to a preoperative nomogram for predicting OS after re-hepatectomy and actually underwent re-hepatectomy between 2006 and 2012 were analyzed.All these patients had a solitary and ≤5 cm recurrent HCC.Of them,146 and 181 patients received a wide(≥1 cm)and a narrow margin(<1 cm)re-resections,respectively.Tumor re-recurrence and recurrence to death survival(RTDS)rates were analyzed by the competing risk analysis and Kaplan-Meier method,respectively.Then,another nomogram for predicting MVI risk of recurrence is used to furthermore evaluate the 327 patients,and 297 patients with hepatitis B virus(HBV)infection and performing MRI of the 327 patients were then chosen to predict MVI risk.The performance of preoperative MVI risk evaluation nomogram was assessed by concordance index(c-index)and calibration curve.Finally,overall survival rates were compared in the patients depends on margin width differentiated from the MVI status.Results: The incidences of surgical complication between the wide and narrow margin groups were comparable(29.6% vs.22.6%,p=0.300).The 5-year re-recurrence and RTDS rates were similar between two groups(67.6% vs.75.5%,p=0.064;56.9% vs.45.6%,p=0.080).In patients with MVI identified pathologically,the wide margin group had better 5-year re-recurrence and RTD than the narrow margin group(61.5% vs.91.3%,p<0.001;63.9% vs.16.5%,p<0.001).Such differences were not identified among patients who had no pathological MVI.The nomogram performed well in predicting MVI presence demonstrated by good c-index(0.817)and well-fitted calibration curve.A wide margin re-hepatectomy resulted in better results in patients with a high-MVI risk(re-recurrence:70.7% vs.89.8%,p=0.004;RTDS: 60.7% vs.22.2%,p=0.008),but narrow margin did not.Conclusion: Wide margin(≥1 cm)re-hepatectomies for recurrent HCC provided more prognostic benefit to patients with pathological MVI or high estimated MVI risk. |
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