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

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.