David Martínez-Cecilia1,2, Dennis A Wicherts3, Federica Cipriani4, Giammauro Berardi5, Leonid Barkhatov6,7, Panagiotis Lainas8, Mathieu D'Hondt9, Fernando Rotellar10, Ibrahim Dagher8, Luca Aldrighetti4, Roberto I Troisi5, Bjorn Edwin6,7, Mohammad Abu Hilal3,11. 1. Department of Hepatobiliary and Pancreatic Surgery, University Hospital Southampton NHS Foundation Trust, E Level Tremona Road, Southampton, SO16 6YD, UK. cordcuen@hotmail.com. 2. Department of Hepatobiliary Surgery, Hospital Universitario de Toledo, Toledo, Spain. cordcuen@hotmail.com. 3. Department of Hepatobiliary and Pancreatic Surgery, University Hospital Southampton NHS Foundation Trust, E Level Tremona Road, Southampton, SO16 6YD, UK. 4. Department of Surgery, Hepatobiliary Surgery Unit, San Raffaele Scientific Institute, Milan, Italy. 5. Department of General, Hepatobiliary and Liver Transplantation Surgery, Ghent University Hospital Medical School, Ghent, Belgium. 6. Department of Hepatic, Pancreatic and Biliary Surgery, Leader Professor at The Intervention Centre, Oslo University Hospital, Oslo, Norway. 7. Institute of Clinical Medicine, Oslo, Norway. 8. Department of Digestive Minimally Invasive Surgery, Antoine Béclère Hospital, Paris, France. 9. Department of Digestive and Hepatobiliary/Pancreatic Surgery, Groeninge Hospital, Kortrijk, Belgium. 10. Department of General and Digestive Surgery, Clinica Universidad de Navarra, Pamplona, Spain. 11. Department of Hepato-Biliary and Pancreatic Surgery, Instituto Fondazione Poliambulanza, Brescia, Italy.
Abstract
BACKGROUND: There is no clear consensus over the optimal width of resection margin for colorectal liver metastases (CRLM), with evolving definitions alongside the advances on the management of the disease. In addition, data on the impact of resection margin after laparoscopic liver resection are still scarce. METHODS: Prospectively maintained databases of patients undergoing open or laparoscopic CRLM resection in 7 European tertiary hepatobiliary referral centres were reviewed. After propensity score matching (PSM), the influence of 1 mm and wider margins on OS and DFS were evaluated in open and laparoscopic cohorts. RESULTS: After PSM, 648 patients were comparable in each group. The incidence of positive margins (< 1 mm) was similar in open and laparoscopic groups (17% vs 13%, p = 0,142). Margins < 1 mm were associated with shorter RFS in open (12 vs 26 months, p = 0.042) and in laparoscopic group (13 vs 23, p = 0,002). Margins < 1 mm were associated with shorter OS in open (36 vs 57 months, p = 0.027), but not in laparoscopic group (49 vs 60, p = 0,177). Subgroups with margins ≥ 1 mm (1-4 mm, 5-9 mm, ≥ 10 mm) presented similar RFS in open (p = 0,251) or laparoscopic cohorts (p = 0.117), as well as similar OS in open (p = 0.295) or laparoscopic cohorts (p = 0.908). In the presence of liver recurrence, repeat liver resection was performed in 70 (30%) patients in the open group and 88 (48%) in the laparoscopic group (p < 0.001). CONCLUSIONS: Our study suggests that a positive resection margin (less than 1 mm) width does not impact OS after laparoscopic resection of CRLMs as it does in open liver resection. However, a positive margin continues to affect RFS in open and laparoscopic resection. Wider margins than 1 mm do not seem to improve oncological results in open or laparoscopic surgery.
BACKGROUND: There is no clear consensus over the optimal width of resection margin for colorectal liver metastases (CRLM), with evolving definitions alongside the advances on the management of the disease. In addition, data on the impact of resection margin after laparoscopic liver resection are still scarce. METHODS: Prospectively maintained databases of patients undergoing open or laparoscopic CRLM resection in 7 European tertiary hepatobiliary referral centres were reviewed. After propensity score matching (PSM), the influence of 1 mm and wider margins on OS and DFS were evaluated in open and laparoscopic cohorts. RESULTS: After PSM, 648 patients were comparable in each group. The incidence of positive margins (< 1 mm) was similar in open and laparoscopic groups (17% vs 13%, p = 0,142). Margins < 1 mm were associated with shorter RFS in open (12 vs 26 months, p = 0.042) and in laparoscopic group (13 vs 23, p = 0,002). Margins < 1 mm were associated with shorter OS in open (36 vs 57 months, p = 0.027), but not in laparoscopic group (49 vs 60, p = 0,177). Subgroups with margins ≥ 1 mm (1-4 mm, 5-9 mm, ≥ 10 mm) presented similar RFS in open (p = 0,251) or laparoscopic cohorts (p = 0.117), as well as similar OS in open (p = 0.295) or laparoscopic cohorts (p = 0.908). In the presence of liver recurrence, repeat liver resection was performed in 70 (30%) patients in the open group and 88 (48%) in the laparoscopic group (p < 0.001). CONCLUSIONS: Our study suggests that a positive resection margin (less than 1 mm) width does not impact OS after laparoscopic resection of CRLMs as it does in open liver resection. However, a positive margin continues to affect RFS in open and laparoscopic resection. Wider margins than 1 mm do not seem to improve oncological results in open or laparoscopic surgery.
Authors: K Shirabe; K Takenaka; T Gion; Y Fujiwara; M Shimada; K Yanaga; T Maeda; K Kajiyama; K Sugimachi Journal: Br J Surg Date: 1997-08 Impact factor: 6.939
Authors: Sebastian Knitter; Andreas Andreou; Daniel Kradolfer; Anika Sophie Beierle; Sina Pesthy; Anne-Christine Eichelberg; Anika Kästner; Linda Feldbrügge; Felix Krenzien; Mareike Schulz; Vanessa Banz; Anja Lachenmayer; Matthias Biebl; Wenzel Schöning; Daniel Candinas; Johann Pratschke; Guido Beldi; Moritz Schmelzle Journal: J Clin Med Date: 2020-12-13 Impact factor: 4.241