Outcome of Microscopic Incomplete Resection (R1) of Colorectal Liver Metastases in the Era of Neoadjuvant Chemotherapy

Abstract

BackgroundData from patients with colorectal liver metastases (CRLM) who received neoadjuvant chemotherapy before resection were reviewed and evaluated to see whether neoadjuvant chemotherapy influences the predictive outcome of R1 resections (margin is 0 mm) in patients with CRLM.MethodsBetween January 2000 and December 2008, all consecutive patients undergoing liver resection for CRLM were analyzed. Patients were divided into those who did and did not receive neoadjuvant chemotherapy. The outcome after R0 (tumor-free margin >0 mm) and R1 (tumor-free margin 0 mm) resection was compared.ResultsA total of 264 were eligible for analysis. Median follow-up was 34 months. Patients without chemotherapy showed a significant difference in median disease-free survival (DFS) after R0 or R1 resection: 17 [95% confidence interval (CI) 10–24] months versus 8 (95% CI 4–12) months (P < 0.001), whereas in patients with neoadjuvant chemotherapy the difference in DFS between R0 and R1 resection was not significant: 18 (95% CI 10–26) months versus 9 (95% CI 0–20) months (P = 0.303). Patients without chemotherapy showed a significant difference in median overall survival (OS) after R0 or R1 resection: 53 (95% CI 40–66) months versus 30 (95% CI 13–47) months (P < 0.001). In patients with neoadjuvant chemotherapy, the median OS showed no significant difference: 65 (95% CI 39–92) months for the R0 group versus the R1 group, in whom the median OS was not reached (P = 0.645).ConclusionsIn patients treated with neoadjuvant chemotherapy, R1 resection was of no predictive value for DFS and OS.

Impact of surgical margins on overall and recurrence-free survival in parenchymal-sparing laparoscopic liver resections of colorectal metastases

“…In our opinion, these data are reinforcing the concept that recurrence can be affected more by tumor biology or preexisting micro metastases rather than the margin width, especially in the era of modern chemotherapy [43]. The ideal chemotherapy regimen has not been found yet, but the combination of a biological drug with classical cytotoxic appears to reap the greatest rewards in the treatment of metastatic tumor patterns.…”

“…This can be explained by the fact that the use of CUSA device makes it possible to obtain an additional parenchymal ablation at the edge of the section (of about 7 mm according to the previously mentioned experimental evidence), thus minimizing the risk of getting R1 margins. Therefore, the tumor biology, expressed by the CEA level, may be a more important factor in the patients' overall survival than the width of surgical margins in the era of new surgical devices and chemotherapy in combination with biological drugs [43].…”

Simultaneous resection for colorectal cancer with synchronous liver metastases is a safe procedure: Outcomes at a single center in Turkey

“…In the current study, R1 resection was performed at a similar rate among the 3 groups: 12.5% for patients with cancer of the right side of the colon, 12.5% for those with cancer of the left side of the colon, and 4.5% for those with rectal cancer. These rates are low in comparison to the range (5-46%) reported in other studies (8,30,31,(33)(34)(35)(36)(37). Preoperative chemotherapy is widely used in the early treatment of metastatic disease to improve patient eligibility for surgical resection and to decrease the rate of recurrence after surgery (38).…”

Surgery for Colorectal Cancer - Trends, Developments, and Future Perspectives

“…However, with these multimodal concepts, some recent findings have to be taken into account. First of all, in the surgical treatment of colorectal hepatic metastases, achievement of an R0 situation appears to be mandatory for a positive long-term prognosis even in the era of perioperative chemotherapy [32,33,34,35,36]. However, in some patients, resectability criteria may not be fulfilled at the time of diagnosis, but may be achieved by reducing the size and/or number of the metastases preoperatively.…”