What does this research mean for the field?

Wide resection margins do not improve survival outcomes in early-stage hepatocellular carcinoma following anatomical resection, but may provide disease-free survival benefits for intermediate-stage patients while increasing the risk of postoperative complications. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

This study evaluates whether wide resection margins improve survival outcomes in early-stage hepatocellular carcinoma patients undergoing anatomical resection.

May 21, 2026Open Access

Wide resection margin fails to demonstrate improved survival outcomes in early-stage hepatocellular carcinoma following anatomical resection: A propensity score-matched analysis from two tertiary centers

Key Points

This study evaluates whether wide resection margins improve survival outcomes in early-stage hepatocellular carcinoma patients undergoing anatomical resection.
Conducted a multicenter database analysis of 538 HCC patients who underwent anatomical resection.
Utilized propensity score matching to compare outcomes between wide and narrow resection margins.
Performed Cox regression analysis to identify prognostic factors affecting overall and disease-free survival.
No significant differences in overall survival (p > 0.05) or disease-free survival (p > 0.05) were found between wide and narrow margin groups.
Higher rates of post-hepatectomy liver failure and ascites were observed in the wide margin group (p < 0.05).
Wide margins showed some benefit for disease-free survival in intermediate-stage patients (BCLC stage B) but not in early-stage patients (BCLC stage 0/A).

Abstract

BACKGROUND: The influence of wide resection margins (RM) on long-term outcomes in hepatocellular carcinoma (HCC) patients undergoing anatomical resection (AR) remains underexplored. This study aims to comprehensively evaluate the clinical implications of wide versus narrow resection margins by analyzing multiple prognostic indicators. PATIENTS AND METHODS: A multicenter database identified HCC patients who had undergone AR.Early recurrence rates, recurrence patterns, postoperative complications,90-day mortality, overall survival(OS),disease-free survival(DFS),and potential risk factors were analyzed in HCC patients using propensity score matching(PSM),COX regression analysis and subgroup analysis. RESULTS: The study cohort comprised 538 HCC patients, stratified into wide (n = 217) and narrow (n = 321) resection margin groups. PSM analysis revealed comparable OS and DFS outcomes between the two groups (both p > 0.05). Comparative analysis showed no statistically significant differences in early recurrence rates, recurrence patterns (intrahepatic, extrahepatic, or combined), or 90-day mortality rates, either before or after PSM adjustment (all P > 0.05). However, analysis of postoperative complications revealed significantly higher rates of post-hepatectomy liver failure (PHLF) and ascites in the wide resection margin group compared to the narrow margin group, consistent across both pre-PSM and post-PSM analyses (all P < 0.05). Multivariate Cox regression analysis showed that neither microvascular invasion (MVI) status nor resection margin width independently predicted improved OS or DFS. In subgroup analyses, wide RM improved DFS in HCC patients at intermediate stage (BCLC stage B), but not in those at early stage (BCLC stage 0/A). CONCLUSIONS: Wide RM may benefit HCC patients at intermediate stage (BCLC stage B), but not those at early stage (BCLC stage 0/A) undergoing AR.

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