Significance of surgical resection and resection margins for hepatocellular carcinoma with microvascular invasion: a systematic review and meta-analysis.

Objective: For hepatocellular carcinoma (HCC) with microvascular invasion (MVI), the choice of surgical resection (SR) and resection margins (RMs) remains to be determined. The aim of this study was to discuss the relationship between SR and RM and MVI-positive HCC.

Methods: PubMed, Embase, Web of Science, and Cochrane Library were searched up to 1 September 2024. The methodological quality of eligible articles was assessed using the Newcastle-Ottawa Scale (NOS). Effect models were selected to pool the HR and 95% CI of recurrence and overall survival (OS) based on the presence of heterogeneity to assess the impact of SR and RM in MVI-positive HCC.

Results: A total of 12 articles with 6747 cases were included. NOS scale indicated that the studies were of high quality. The results showed that narrow RM were a risk factor for postoperative recurrence and OS in MVI-positive HCC, with a pooled HR of 1.76 (95% CI: 1.49, 2.07) and 1.99 (95% CI: 1.58, 2.49), respectively; whereas nonanatomical resection (NAR) was another risk factor for postoperative recurrence and OS, with a pooled HR of 1.33 (95% CI: 1.15, 1.54) and 1.42 (95% CI: 1.15, 1.75), so wide RM and anatomical resection (AR) was beneficial for postoperative recurrence and long-term survival. In the subgroups, narrow RM were more than twice the risk factor for TTR compared with wide RM; and in the SR subgroup, studies from the Japanese had more than double the risk factor for postoperative recurrence and OS compared with China.

Conclusion: For HCC with MVI, treatment modalities recommending anatomical resection and wide margins will have beneficial effects on postoperative recurrence and long-term survival.