BACKGROUND: A safety margin of > or =10 mm is generally accepted in surgery for colorectal metastases. It is reasonable that modern methods of liver parenchyma dissection may allow for a reduction in this distance. METHODS: A total of 333 patients were included in a multicenter trial after resection of colorectal liver metastases. Dissection of the liver had been performed with a CUSA, UltraCision, or water-jet dissector. The size of the resection margin was correlated with recurrence risk and survival. RESULTS: The median hepatic recurrence-free survival reached 35 months for all patients; median recurrence-free survival was 24 months and overall survival was 41 months. Univariate analysis of different groups denoting the extent of resection margin (> or =10 mm, 6-9 mm, 3-5 mm, 1-2 mm, 0 mm (R1)) indicated that a margin of 1-2 mm leads to a significantly reduced median hepatic recurrence-free survival of 20 months (p = 0.004) and recurrence-free survival of 19 months (p = 0.011). Patients with R1 resection had the worst prognosis. Overall survival was not influenced by the size of the resection margin. Surgical margins were significantly reduced in simultaneous resections of four or more liver metastases and in cases in which metastatic infiltration of central liver segments was present. At multivariate analysis, resection margins of 1-2 mm and 0 mm were independent predictors of hepatic recurrence and overall recurrence. CONCLUSION: The indication for resection of metastases can be safely extended to cases in which tumors sit closer than 1 cm to nonresectable structures.
BACKGROUND: A safety margin of > or =10 mm is generally accepted in surgery for colorectal metastases. It is reasonable that modern methods of liver parenchyma dissection may allow for a reduction in this distance. METHODS: A total of 333 patients were included in a multicenter trial after resection of colorectal liver metastases. Dissection of the liver had been performed with a CUSA, UltraCision, or water-jet dissector. The size of the resection margin was correlated with recurrence risk and survival. RESULTS: The median hepatic recurrence-free survival reached 35 months for all patients; median recurrence-free survival was 24 months and overall survival was 41 months. Univariate analysis of different groups denoting the extent of resection margin (> or =10 mm, 6-9 mm, 3-5 mm, 1-2 mm, 0 mm (R1)) indicated that a margin of 1-2 mm leads to a significantly reduced median hepatic recurrence-free survival of 20 months (p = 0.004) and recurrence-free survival of 19 months (p = 0.011). Patients with R1 resection had the worst prognosis. Overall survival was not influenced by the size of the resection margin. Surgical margins were significantly reduced in simultaneous resections of four or more liver metastases and in cases in which metastatic infiltration of central liver segments was present. At multivariate analysis, resection margins of 1-2 mm and 0 mm were independent predictors of hepatic recurrence and overall recurrence. CONCLUSION: The indication for resection of metastases can be safely extended to cases in which tumors sit closer than 1 cm to nonresectable structures.
Authors: Chandrakanth Are; Mithat Gonen; Kathleen Zazzali; Ronald P Dematteo; William R Jarnagin; Yuman Fong; Leslie H Blumgart; Michael D'Angelica Journal: Ann Surg Date: 2007-08 Impact factor: 12.969
Authors: Y Seium; R Stupp; T Ruhstaller; P Gervaz; G Mentha; M Philippe; A Allal; C Trembleau; J Bauer; R Morant; A D Roth Journal: Ann Oncol Date: 2005-04-07 Impact factor: 32.976
Authors: Stefan Schmidbauer; Klaus K Hallfeldt; Günther Sitzmann; Thorsten Kantelhardt; Arnold Trupka Journal: Ann Surg Date: 2002-01 Impact factor: 12.969
Authors: Timothy M Pawlik; Charles R Scoggins; Daria Zorzi; Eddie K Abdalla; Axel Andres; Cathy Eng; Steven A Curley; Evelyne M Loyer; Andrea Muratore; Gilles Mentha; Lorenzo Capussotti; Jean-Nicolas Vauthey Journal: Ann Surg Date: 2005-05 Impact factor: 12.969
Authors: Y Fong; A M Cohen; J G Fortner; W E Enker; A D Turnbull; D G Coit; A M Marrero; M Prasad; L H Blumgart; M F Brennan Journal: J Clin Oncol Date: 1997-03 Impact factor: 44.544
Authors: S Ambiru; M Miyazaki; T Isono; H Ito; K Nakagawa; H Shimizu; K Kusashio; S Furuya; N Nakajima Journal: Dis Colon Rectum Date: 1999-05 Impact factor: 4.585
Authors: J Figueras; F Burdio; E Ramos; J Torras; L Llado; S Lopez-Ben; A Codina-Barreras; S Mojal Journal: Ann Oncol Date: 2007-04-13 Impact factor: 32.976
Authors: C S D Roxburgh; C H Richards; S J Moug; A K Foulis; D C McMillan; P G Horgan Journal: Int J Colorectal Dis Date: 2011-11-17 Impact factor: 2.571
Authors: Sung Hwan Lee; Sung Hyun Kim; Jin Hong Lim; Sung Hoon Kim; Jin Gu Lee; Dae Joon Kim; Gi Hong Choi; Jin Sub Choi; Kyung Sik Kim Journal: Korean J Hepatobiliary Pancreat Surg Date: 2016-08-29
Authors: Dries Vandeweyer; Eu Ling Neo; John W C Chen; Guy J Maddern; Thomas G Wilson; Robert T A Padbury Journal: HPB (Oxford) Date: 2009-09 Impact factor: 3.647