Comparison Between the Minimum Margin Defined on Preoperative Imaging and the Final Surgical Margin After Hepatectomy for Cancer: How to Manage It?

Abstract

The liver surgeon must consider that roughly a 5 to 8 mm tumor-free margin will disappear during hepatectomy when comparing measurements on the basis of preoperative imaging versus tumor-free specimen margins. If the histologically assessed minimum 2-mm tumor-free margin is added, the surgeon must plan to have a 7 to 10 mm tumor-free margin on preoperative imaging. However, few technical solutions exist that would enable the surgeon to increase the safety margin in borderline cases.

Comparison of liver parenchymal ablation and tissue necrosis in a cadaveric bovine model using the Harmonic Scalpel™, the LigaSure™, the Cavitron Ultrasonic Surgical Aspirator® and the Aquamantys® devices

“…Resection margin status is an important prognostic factor following liver resection for colorectal metastases and has implications for the planning of future treatment . However, the accurate interpretation of margin status is difficult as the use of ablative transection techniques may encroach on the clear margin and lead to the over‐reporting of false positive margins .…”

“…Several studies now indicate that a resection margin of < 10 mm should not preclude a patient from undergoing liver resection, provided the margin itself is clear of tumour (i.e. there is no tumour within 1 mm of the cut surface of the liver) . However, interpreting these data is difficult because the evidence from prospective trials is limited.…”

Surgical Treatment of Neuroendocrine Liver Metastases

“…The optimal width of the resection margin is confounded by the different parenchymal transection techniques used at different centers [85]. The loss of a 5- to 8-mm tumor-free margin during liver resection confounds the issue of adequacy of pathologic margins and the use of contrast-enhanced intraoperative ultrasound may enhance the accuracy of resection margins [86, 87]. Comparisons of anatomic and wedge resections for CLM have demonstrated no difference in the rate of positive margins, recurrence patterns, or overall survival [88–90].…”

“…In view of this, some have suggested that nonanatomic resection for CLM should at a minimum attain negative pathologic margins with the goal of a 1 cm margin. In contrast, some authors report that the width of the resection margin does not influence survival as long as it is negative [86, 92–95]. Complete resection is the goal of hepatectomy for neuroendocrine liver metastases as the rate of recurrence and the median time to recurrence are negatively affected by incomplete resection [13, 19, 23].…”

Effect of ionomer on clay dispersions in polypropylene‐layered silicate nanocomposites

“…However, objective response rates to second‐line preoperative chemotherapy are only 4%‐28%, hence surgery is rarely an option after failure of first‐line chemotherapy 6‐10. Furthermore, the safety, efficacy, and outcome of hepatic surgery in patients who received multiple lines of chemotherapy have been evaluated only in small series of patients who received cetuximab or intra‐arterial hepatic artery chemotherapy infusion as a “rescue” regimen 11‐13…”