Preoperative Chemotherapy and Resection Margin Status in Colorectal Liver Metastasis Patients: A Propensity Score–Matched Analysis

Abstract

In this article, we compared the early and long-term outcomes of patients with metastatic colorectal cancer treated with chemotherapy followed by resection with those of patients undergoing surgery first, focusing our analysis on resection margin status. Patients who underwent liver resection with curative intent for colorectal liver metastases from July 2001 to January 2018 were included in the analysis. Propensity score matching was used to reduce treatment allocation bias. The cohort comprised 164 patients; 117 (71.3%) underwent liver resection first, whereas the remaining 47 (28.7%) had preoperative chemotherapy. After a 1:1 ratio of propensity score matching, 47 patients per group were evaluated. A positive resection margin was found in 13 patients in the surgery-first group (25.5%) versus 4 (8.5%) in the preoperative chemotherapy group ( P = 0.029). Postmatched logistic regression analysis showed that only preoperative chemotherapy was significantly associated with the rate of positive resection margin (odds ratio 0.24, 95% confidence interval 0.07–0.81; P = 0.022). Median follow-up was 41 months (interquartile range 8–69). Cox proportional hazard regression analysis revealed that only positive resection margin was a significant negative prognostic factor (hazard ratio 2.2, 95% CI 1.18–4.11; P = 0.014). Within the preoperative chemotherapy group, median overall survival was 40 months in R0 patients and 10 months in R1 patients ( P = 0.016). Although preoperative chemotherapy in colorectal liver metastasis patients may affect the rate of positive resection margin, its impact on survival seems to be limited. In the present study, the most important prognostic factor was the resection margin status.

Analysis of survival factors after hepatic resection for colorectal cancer liver metastases: Does the R1 margin matter?

“…The liver margin is an important factor in determining whether radical treatment can be achieved. Over the years, knowledge of the R0 margin of the liver has gradually narrowed from 1 cm to ≥1 mm (9)(10)(11)(12). Even though the R1 margin of the liver is now recognized as less than 1 mm, there are conflicting reports on whether the R1 margin is an independent risk factor for CRLM.…”

Colorectal Cancer Liver Metastases: Is an R1 Hepatic Resection Accepted?

“…The role of preoperative chemotherapy on resection margin status has been also investigated. Solaini et al conducted a retrospective analysis, but with a propensity score matched analysis, and reported that preoperative chemotherapy was significantly associated with the rate of positive resection margin (25.5% vs. 8.5%) [ 10 ]. Aligned in the same direction, a multicenter study by Benedetti et al analyzed a cohort of 3387 patients who underwent open or laparoscopic liver resection for CRLM in nine European high-volume referral centers.…”

Current trends in liver surgery (literature review)

“…Полное удаление метастазов является наиболее эффективным путем лечения больных колоректальным раком с поражением печени, при котором потенциально возможно радикальное излечение [3][4][5]. Статус края резекции при метастазах колоректального рака в печени (МКРП) признан прогностическим фактором, и целью хирургического лечения является достижение негативного края [6]. Ранее признанное расстояние в 10 мм [7,8] с течением времени уменьшали [9,10].…”