Surgical margin status in hepatectomy for liver tumors

Abstract

It is admitted that only complete tumor clearance with negative surgical margins provides benefit for patients undergoing surgery for hepatobiliary malignancies. For hepatocellular carcinoma, since micrometastases disseminate via portal venous branches, anatomic resection is preferred over non-anatomic resection in liver resection carried out with curative intent. Thus, an anatomic liver resection with a wider resection margin theoretically gives a higher potential for cure. However, preserving non-tumorous liver parenchyma is an important consideration, especially in cirrhotic liver resection to decrease the incidence of postoperative liver failure. The optimal liver resection margin is still controversial. It seems that a resection margin of 2 cm is associated with a decreased postoperative recurrence rate and improved survival outcomes especially for hepatocellular carcinoma <or= 2 cm. Due to the unsatisfying alternatives in the medical and interventional treatment of intrahepatic cholangiocarcinoma, hepatic resection, whenever technically possible, should be enforced. Expected narrow hepatic resection margins should not exclude patients from potentially curative surgery, and should not be used as a reason to establish palliative treatment instead since R1 resection is compatible with long-term survival. Aggressive hepatic surgery could and should therefore be performed if the peri-operative mortality is low. For hilar cholangiocarcinoma, surgical radicality has been shown in multivariate analyses of multiples studies to be the only parameter with a significant impact on survival. Extended right-side hepatectomies seems to give the best oncologic results. A predicted margin of < 1 cm after resection of hepatic colorectal metastases should not be used as an exclusion criterion for resection and will not impair patients' prognosis. Resection should be performed whatever the width of the surgical margin, rather than not performing the resection at all.