OBJECTIVE: To investigate the influence of clear surgical resection margin width on disease recurrence rate after intentionally curative resection of colorectal liver metastases. BACKGROUND: There is consensus that a histological positive resection margin is a predictor of disease recurrence after resection of colorectal liver metastases. The dispute, however, over the width of cancer-free resection margin required is ongoing. METHODS: Analysis of observational prospectively collected data for 2715 patients who underwent primary resection of colorectal liver metastases from 2 major hepatobiliary units in the United Kingdom. Histological cancer-free resection margin was classified as positive (if cancer cells present at less than 1 mm from the resection margin) or negative (if the distance between the cancer and the margin is 1 mm or more). The negative margin was further classified according to the distance from the tumor in millimeters. Predictors of disease-free survival were analyzed in univariate and multivariate analyses. A case-match analysis by a propensity score method was undertaken to reduce bias. RESULTS: A 1-mm cancer-free resection margin was sufficient to achieve 33% 5-year overall disease-free survival. Extra margin width did not add disease-free survival advantage (P > 0.05). After the propensity case-match analysis, there is no statistical difference in disease-free survival between patients with negative narrow and wider margin clearance [hazard ratio (HR) 1.0; 95% (confidence interval) CI: 0.9-1.2; P = 0.579 at 5-mm cutoff and HR 1.1; 95% CI: 0.96-1.3; P = 0.149 at 10-mm cutoff]. Patients with extrahepatic disease and positive lymph node primary tumor did not have disease-free survival advantage despite surgical margin clearance (9 months for <1-mm vs 12 months for ≥1-mm margin clearance; P = 0.062). CONCLUSION: One-mm cancer-free resection margin achieved in patients with colorectal liver metastases should now be considered the standard of care.
OBJECTIVE: To investigate the influence of clear surgical resection margin width on disease recurrence rate after intentionally curative resection of colorectal liver metastases. BACKGROUND: There is consensus that a histological positive resection margin is a predictor of disease recurrence after resection of colorectal liver metastases. The dispute, however, over the width of cancer-free resection margin required is ongoing. METHODS: Analysis of observational prospectively collected data for 2715 patients who underwent primary resection of colorectal liver metastases from 2 major hepatobiliary units in the United Kingdom. Histological cancer-free resection margin was classified as positive (if cancer cells present at less than 1 mm from the resection margin) or negative (if the distance between the cancer and the margin is 1 mm or more). The negative margin was further classified according to the distance from the tumor in millimeters. Predictors of disease-free survival were analyzed in univariate and multivariate analyses. A case-match analysis by a propensity score method was undertaken to reduce bias. RESULTS: A 1-mm cancer-free resection margin was sufficient to achieve 33% 5-year overall disease-free survival. Extra margin width did not add disease-free survival advantage (P > 0.05). After the propensity case-match analysis, there is no statistical difference in disease-free survival between patients with negative narrow and wider margin clearance [hazard ratio (HR) 1.0; 95% (confidence interval) CI: 0.9-1.2; P = 0.579 at 5-mm cutoff and HR 1.1; 95% CI: 0.96-1.3; P = 0.149 at 10-mm cutoff]. Patients with extrahepatic disease and positive lymph node primary tumor did not have disease-free survival advantage despite surgical margin clearance (9 months for <1-mm vs 12 months for ≥1-mm margin clearance; P = 0.062). CONCLUSION: One-mm cancer-free resection margin achieved in patients with colorectal liver metastases should now be considered the standard of care.
Authors: Georgios Antonios Margonis; Stefan Buettner; Nikolaos Andreatos; Yuhree Kim; Doris Wagner; Kazunari Sasaki; Andrea Beer; Christoph Schwarz; Inger Marie Løes; Maria Smolle; Carsten Kamphues; Jin He; Timothy M Pawlik; Klaus Kaczirek; George Poultsides; Per Eystein Lønning; John L Cameron; Richard A Burkhart; Armin Gerger; Federico N Aucejo; Martin E Kreis; Christopher L Wolfgang; Matthew J Weiss Journal: JAMA Surg Date: 2018-07-18 Impact factor: 14.766
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Authors: Teresa Schreckenbach; Patrizia Malkomes; Wolf O Bechstein; Guido Woeste; Andreas A Schnitzbauer; Frank Ulrich Journal: Surg Today Date: 2015-01-07 Impact factor: 2.549
Authors: Bas Groot Koerkamp; Eran Sadot; Nancy E Kemeny; Mithat Gönen; Julie N Leal; Peter J Allen; Andrea Cercek; Ronald P DeMatteo; T Peter Kingham; William R Jarnagin; Michael I D'Angelica Journal: J Clin Oncol Date: 2017-04-20 Impact factor: 44.544
Authors: Eran Sadot; Bas Groot Koerkamp; Julie N Leal; Jinru Shia; Mithat Gonen; Peter J Allen; Ronald P DeMatteo; T Peter Kingham; Nancy Kemeny; Leslie H Blumgart; William R Jarnagin; Michael I DʼAngelica Journal: Ann Surg Date: 2015-09 Impact factor: 12.969