The Impact of Margins on Outcome After Hepatic Resection for Colorectal Metastasis

Are, Chandrakanth; Gönen, Mithat; Zazzali, Kathleen; DeMatteo, Ronald P.; Jarnagin, William R.; Fong, Yuman; Blumgart, Leslie H.; D’Angelica, Michael I.

doi:10.1097/sla.0b013e31811ea962

Cited by 217 publications

(194 citation statements)

References 26 publications

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“…More wedge resections can be performed because several recent studies have indicated that a margin less than 1 cm is not a contraindication to resection of colorectal liver metastases. [22][23][24][25] Moreover, a margin of 1 mm seems to be appropriate, despite the fact that the pathological report will define the procedure as a microscopic irradical resection. 24 Current techniques with ultrasonic dissectors aspirate a part of the liver parenchyma interposed between the specimen and the normal liver, making assessment of the true margin difficult.…”

Section: Discussionmentioning

confidence: 99%

Local Treatment for Recurrent Colorectal Hepatic Metastases after Partial Hepatectomy

Pool

Lalmahomed

Wilt

et al. 2009

Journal of Gastrointestinal Surgery

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Objective The objective of the study was to identify patients who may benefit from local treatment in recurrent colorectal liver metastases. Materials and methods A total of 51 consecutive patients were treated for hepatic recurrence(s) after an initial partial hepatic resection. Surgery was considered as the primary treatment option for eligible patients. Patients with a small liver remnant after major hepatectomy were treated with radiofrequency ablation (RFA) or stereotactic body radiation therapy (SRx). SRx was given as an outpatient, emerging local treatment option for patients with intra-hepatic recurrences not eligible for surgery or RFA. Partial liver resection was performed in 36 patients (70%), RFA in ten patients (20%), and SRx in five patients (10%). Results Median hospital stay was 7 (range, 3-62) days with a morbidity of 16% without in-hospital death. None of the patients received adjuvant chemotherapy. There was no difference in recurrence or survival between the three treatment modalities. Overall 5-year survival was 35% with an estimated median survival of 37 months. Patients with a disease-free interval between first hepatectomy and hepatic recurrence less than 6 months did not survive 3 years. Conclusions Resection, RFA, and SRx can be performed safely in patients with recurrent colorectal liver metastases and offer a survival that seems comparable to primary liver resections of colorectal liver metastases.

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Section: Discussionmentioning

confidence: 99%

Local Treatment for Recurrent Colorectal Hepatic Metastases after Partial Hepatectomy

Pool

Lalmahomed

Wilt

et al. 2009

Journal of Gastrointestinal Surgery

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“…The inclusion of the resection margin in this analysis can be considered controversial, since, in practice, patients with compromised resection margins do not present disease-free intervals (12) . However, the data of studies with strict control of the resection margins show that although such patients have lower rates of disease-free survival, recurrence does not occur more frequently in the resection margin (probable site of residual disease), but in other parts of the liver or other organs (3,18,20) . Regarding the presence of extrahepatic disease at diagnosis, it is understandable that the pattern of dissemination does in fact strongly contribute to the emergence of new foci of disease after surgery.…”

Section: Discussionmentioning

confidence: 99%

Prognostic factors for survival in patients with colorectal liver metastases: experience of a single brazilian cancer center

Ribeiro

Stevanato-Filho

Costa

et al. 2012

Arq. Gastroenterol.

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-Context -Liver metastases are a common event in the clinical outcome of patients with colorectal cancer and account for 2/3 of deaths from this disease. There is considerable controversy among the data in the literature regarding the results of surgical treatment and prognostic factors of survival, and no analysis have been done in a large cohort of patients in Brazil. Objectives -To characterize the results of surgical treatment of patients with colorectal liver metastases, and to establish prognostic factors of survival in a Brazilian population. Method -This was a retrospective study of patients undergoing liver resection for colorectal metastases in a tertiary cancer hospital from 1998 to 2009. We analyzed epidemiologic variables and the clinical characteristics of primary tumors, metastatic disease and its treatment, surgical procedures and follow-up, and survival results. Survival analyzes were done by the Kaplan-Meier method and the log-rank test was applied to determine the influence of variables on overall and disease-free survival. All variables associated with survival with P<0.20 in univariate analysis, were included in multivariate analysis using a Cox proportional hazard regression model. Results -During the period analyzed, 209 procedures were performed on 170 patients. Postoperative mortality in 90 days was 2.9% and 5-year overall survival was 64.9%. Its independent prognostic factors were the presence of extrahepatic disease at diagnosis of liver metastases, bilateral nodules and the occurrence of major complications after liver surgery. The estimated 5-year disease-free survival was 39.1% and its prognostic factors included R1 resection, extrahepatic disease, bilateral nodules, lymph node involvement in the primary tumor and primary tumors located in the rectum. Conclusion -Liver resection for colorectal metastases is safe and effective and the analysis of prognostic factors of survival in a large cohort of Brazilian patients showed similar results to those pointed in international series. The occurrence of major postoperative complications appears to be able to compromise overall survival and further investigation in needed in this topic. HEADINGS -Colorectal neoplasm. Liver neoplasms, secondary. Hepatectomy. Prognosis.

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“…Hepatic resection remains a well accepted modality in the treatment of patients with colorectal liver metastases (CRLM) with 5 year overall survival (OS) ranging from 37 % to 58 % [1][2][3][4] and 5 year disease free survival (DFS) ranging from 11 % to 50 % [3,[5][6][7][8][9][10][11][12][13][14]. Recurrence of the disease after resection still remains a challenge and adversely affects the long term outcomes.…”

Section: Introductionmentioning

confidence: 99%

Influence of Margins on Disease Free Survival Following Hepatic Resection for Colorectal Metastasis: A Meta-Analysis

Dhir

Lyden

Smith

et al. 2012

Indian J Surg Oncol

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The aim of our study was to conduct a metaanalysis of reports published on hepatic resection for colorectal liver metastases (CRLM) and determine if a negative margin ≥1 cm confers a disease free survival (DFS) advantage over sub-centimeter negative margins. The 357 initially selected articles were screened to identify 90 articles of interest of which eleven were finally included in the metaanalysis. Patients with positive margins were excluded from the meta-analysis. Meta-analysis was performed using STATA 9.2 statistical software. A total of 1,989 patients with negative margins from the eleven studies were included in the meta-analysis. The 5-year DFS for all patients was 27.9 % (95 % CI 23.5 % to 32.2 %). The 5-year DFS for ≥1 cm negative margin subgroup was 34.4 % (95 % CI 27.97 % to 40.7 %) when compared to 21.0 % (95 % CI 17.4 % to 24.7 %) for <1 cm negative margin subgroup. The odds ratio for ≥1 cm negative margins was found to be 0.552 (95 % CI 0.408 to 0.747, p<0.001) when compared to <1 cm negative margins. The results of this meta-analysis demonstrate that in patients undergoing hepatic resection for CRLM, a negative margin≥1 cm may confer a better DFS compared with a sub-centimeter negative margin.

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The Impact of Margins on Outcome After Hepatic Resection for Colorectal Metastasis

Cited by 217 publications

References 26 publications

Local Treatment for Recurrent Colorectal Hepatic Metastases after Partial Hepatectomy

Local Treatment for Recurrent Colorectal Hepatic Metastases after Partial Hepatectomy

Prognostic factors for survival in patients with colorectal liver metastases: experience of a single brazilian cancer center

Influence of Margins on Disease Free Survival Following Hepatic Resection for Colorectal Metastasis: A Meta-Analysis

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