Objective:

To assess the effectiveness and safety of external beam radiotherapy (EBRT) combined with narrow-margin hepatectomy for patients with hepatocellular carcinoma (HCC), specifically focusing on those with a surgical margin ≤ 1 cm.

Key Findings:

• Narrow-margin hepatectomy retains more healthy liver tissue but has a high postoperative recurrence rate, which poses significant challenges for long-term patient outcomes.
• EBRT may improve local control and reduce recurrence by targeting residual tumors at surgical margins.
• No consensus exists on the use of EBRT after narrow-margin hepatectomy, necessitating further evaluation to establish standardized protocols.

Interpretation:

The combination of narrow-margin hepatectomy and EBRT may offer a promising approach to improve outcomes for HCC patients, but further studies are urgently needed to confirm its efficacy and establish best practices.

Limitations:

• Variability in study quality and methodologies.
• Potential publication bias in the included studies.
• Lack of consensus on optimal EBRT protocols post-hepatectomy.
• Heterogeneity among studies may affect the reliability of the findings.

Conclusion:

The systematic review highlights the potential benefits of combining EBRT with narrow-margin hepatectomy for HCC, warranting further investigation.