Surgery for colorectal liver metastases: the impact of resection margins on recurrence and overall survival

Abstract

BackgroundSeveral reports have presented conflicting results regarding the association between resection margins (RMs) and outcome after surgery for colorectal liver metastases (CLM), especially in the era of modern chemotherapy. The purpose of this study was to evaluate the impact of RMs on overall survival (OS), time to recurrence (TTR) and local recurrence (LR) status, particularly for patients treated with preoperative chemotherapy.MethodsA combined retrospective (1998 to 2008) and prospective (2008 to 2010) cohort study of consecutive patients with CLM without extrahepatic disease treated with primary resection at a medium volume centre.ResultsA total of 253 patients with known R status and 242 patients with defined margin width were included in the study. Patients were stratified according to margin width; A: R1, <1 mm (n = 48, 19%), B: 1 to 4 mm (n = 77), C: 5 to 9 mm (n = 46) and D: ≥10 mm (n = 71). Median time to recurrence was 12.8 months, and after five years 21.5% had no recurrence. LR (inclusive combined recurrence in other hepatic sites or extrahepatic) occurred in 40 (16.5%) cases, most frequently seen with RMs below 5 mm. Five-year OS was 42.5% in R0 and 16.1% in R1 resections (P = 0.011). Patients were also stratified according to preoperative chemotherapy (n = 88), and the difference in five-year OS between R0 (45.1%) and R1 (14.7%) was maintained (P = 0.037). By multiple Cox regression analysis R1 resections tended to an adverse outcome (P = 0.067), also when adjusting for preoperative chemotherapy (P = 0.081).ConclusionsR1 resections for colorectal liver metastases predict adverse outcome. RMs below 5 mm increased the risk for LR and shortened the time to recurrence. Preoperative chemotherapy did not alter an adverse outcome in R1 vs. R0 patients.

Functional impairment prior to major non-cardiac surgery is associated with mortality within one year in elderly patients with gastrointestinal, gynaecological and urogenital cancer: A prospective observational cohort study

“…Importantly, these results were independent from the grade of tumour resection. Complete or incomplete resection is one of the main predictors of 1-year survival in cancer patients, as shown in this study and in previous published studies [30,31].…”

RAS Mutation Predicts Positive Resection Margins and Narrower Resection Margins in Patients Undergoing Resection of Colorectal Liver Metastases

“…Therefore, in patients with RAS mutant CLM, we recommend the cautious approach proposed by Are et al 8 of obtaining a 10-mm margin if the margin is not limited by anatomical relationships, even though narrower margins have been proposed by other authors. 39, 40, 44 …”

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.…”