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Zhang XP, Xu S, Lin ZY, Gao QL, Wang K, Chen ZL, Yan ML, Zhang F, Tang YF, Zhao ZM, Li CG, Lau WY, Cheng SQ, Hu MG, Liu R. Significance of anatomical resection and resection margin status in patients with HBV-related hepatocellular carcinoma and microvascular invasion: a multicenter propensity score-matched study. Int J Surg 2023; 109:679-688. [PMID: 36917129 PMCID: PMC10389431 DOI: 10.1097/js9.0000000000000204] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 01/02/2023] [Indexed: 03/16/2023]
Abstract
BACKGROUND Microvascular invasion (MVI) is a risk factor for postoperative survival outcomes for patients with hepatocellular carcinoma (HCC) after hepatectomy. This study aimed to evaluate the impact of anatomical resection (AR) versus nonanatomical resection (NAR) combined with resection margin (RM) (narrow RM <1 cm vs. wide RM ≥1 cm) on long-term prognosis in hepatitis B virus-related HCC patients with MVI. MATERIALS AND METHODS Data from multicenters on HCC patients with MVI who underwent hepatectomy was analyzed retrospectively. Propensity score matching analysis was performed in these patients. RESULTS The 1965 enrolled patients were divided into four groups: AR with wide RM ( n =715), AR with narrow RM ( n =387), NAR with wide RM ( n =568), and NAR with narrow RM ( n =295). Narrow RM ( P <0.001) and NAR ( P <0.001) were independent risk factors for both overall survival and recurrence-free survival in these patients based on multivariate analyses. For patients in both the AR and NAR groups, wide RM resulted in significantly lower operative margin recurrence rates than those patients in the narrow RM groups after propensity score matching ( P =0.002 and 0.001). Patients in the AR with wide RM group had significantly the best median overall survival (78.9 vs. 51.5 vs. 48.0 vs. 36.7 months, P <0.001) and recurrence-free survival (23.6 vs. 14.8 vs. 17.8 vs. 9.0 months, P <0.001) than those in the AR with narrow RM, NAR with wide RM or with narrow RM groups, respectively. CONCLUSIONS If technically feasible and safe, AR combined with wide RM should be the recommended therapeutic strategy for HCC patients who are estimated preoperatively with a high risk of MVI.
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Affiliation(s)
- Xiu-Ping Zhang
- Faculty of Hepato-Biliary-Pancreatic Surgery, Chinese People’s Liberation Army (PLA) General Hospital, Institute of Hepatobiliary Surgery of Chinese PLA, Key Laboratory of Digital Hepatobiliary Surgery, PLA, Beijing
| | - Shuai Xu
- Department of Liver Transplantation and Hepatobiliary Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan
| | - Zhao-Yi Lin
- Faculty of Hepato-Biliary-Pancreatic Surgery, Chinese People’s Liberation Army (PLA) General Hospital, Institute of Hepatobiliary Surgery of Chinese PLA, Key Laboratory of Digital Hepatobiliary Surgery, PLA, Beijing
| | - Qing-Lun Gao
- Department of Hepatobiliary Surgery, Shandong Provincial Third Hospital, Cheeloo College of Medicine, Shandong University, Shandong
| | - Kang Wang
- Department of Hepatobiliary Surgery, Affiliated Hospital of Binzhou Medical College, Shandong
| | - Zi-Li Chen
- Department of Hepatobiliary Surgery, Affiliated Hospital of Guizhou Medical University, Guizhou
| | - Mao-Lin Yan
- Department of Hepato-Biliary-Pancreatic Surgery, Fujian Provincial Hospital, Fujian
| | - Fan Zhang
- Department of Hepatic Surgery VI, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai
| | - Yu-Fu Tang
- Department of Hepatobiliary Surgery, Northern Theater General Hospital, Liaoning
| | - Zhi-Ming Zhao
- Faculty of Hepato-Biliary-Pancreatic Surgery, Chinese People’s Liberation Army (PLA) General Hospital, Institute of Hepatobiliary Surgery of Chinese PLA, Key Laboratory of Digital Hepatobiliary Surgery, PLA, Beijing
| | - Cheng-Gang Li
- Faculty of Hepato-Biliary-Pancreatic Surgery, Chinese People’s Liberation Army (PLA) General Hospital, Institute of Hepatobiliary Surgery of Chinese PLA, Key Laboratory of Digital Hepatobiliary Surgery, PLA, Beijing
| | - Wan Yee Lau
- Faculty of Hepato-Biliary-Pancreatic Surgery, Chinese People’s Liberation Army (PLA) General Hospital, Institute of Hepatobiliary Surgery of Chinese PLA, Key Laboratory of Digital Hepatobiliary Surgery, PLA, Beijing
- Faculty of Medicine, the Chinese University of Hong Kong, Shatin, Hong Kong, SAR, China
| | - Shu-Qun Cheng
- Department of Hepatobiliary Surgery, Affiliated Hospital of Binzhou Medical College, Shandong
| | - Ming-Gen Hu
- Faculty of Hepato-Biliary-Pancreatic Surgery, Chinese People’s Liberation Army (PLA) General Hospital, Institute of Hepatobiliary Surgery of Chinese PLA, Key Laboratory of Digital Hepatobiliary Surgery, PLA, Beijing
| | - Rong Liu
- Faculty of Hepato-Biliary-Pancreatic Surgery, Chinese People’s Liberation Army (PLA) General Hospital, Institute of Hepatobiliary Surgery of Chinese PLA, Key Laboratory of Digital Hepatobiliary Surgery, PLA, Beijing
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