TY - JOUR
T1 - Influence of surgical margin on type of recurrence following liver resection for colorectal metastases: a single-center experience
AU - Nuzzo, Gennaro
AU - Giuliante, Felice
AU - Ardito, Francesco
AU - Vellone, Maria
AU - Giovannini, Ivo
AU - Federico, Bruno
AU - Vecchio, Fabio Maria
PY - 2008
Y1 - 2008
N2 - Background. Hepatectomy for colorectal liver metastases (CRLM) may offer good long-term survival. The impact of the tumor-free surgical margin on long-term results remains controversial, and we have assessed this component in 185 patients.
Methods. Between 1992 and 2005, 185 patients underwent primary hepatectomy with curative intent for CRLM (which originated from colon/rectum 133/52, synchronous/melachronous 66/119, and single/multiple 100/85). In this study, 105 major and 80 minor hepatectomies were evaluated; 133 hepatectomies had pedicle clamping.
Results. Operative mortality was 1.1%, morbidity was 25.7%, and blood transfusion requirement was 27.6%. Stratification of tumor-free margin in the patients with R0 liver resection was greater than or equal to 10 mm (63.0% of patients), 6-9 mm (11.4% of patients), 3-5 mm (16.5% of patients), and less than or equal to 2 mm (9.1% of patients), with infiltrated margin in the remainder (R1 liver resection 4.9% of the total number of patients). The 3-year, 5-year, and 10-year survival rates were 54.9%, 37.9%, and 22.9%, respectively. Global and surgical margin recurrence rates increased as the tumor-free margin decreased (P =. 01 and P <. 001, respectively). At univariate analysis, the width of surgical margin (P <. 001), transfusion requirement, major hepatectomy, RI resection, number of metastases, high Preoperative CEA, and increasing tumor size (P value from. 001 to. 03) were associated with lesser rates of long-term survival. A similar association was found with disease free survival. At multivariate analysis, width of surgical margin was the only independent predictor of both overall (P =. 003) and disease free (P <. 001) survival. Although smaller margins were associated with synchronicity, increasing number of, and with bilobar distribution of, metastases which contributed to explaine recurrences away from the margin), the width of surgical margin maintained the prominent impact on outcome.
Conclusions. In our patients, the width of the surgical. margin was a powerful prognostic factor after hepatectomy for CRLM. A resection margin less than or equal to 5 mm was associated with a greater risk of recurrence on the surgical margin, with a lesser rate of overall and disease free survival.
AB - Background. Hepatectomy for colorectal liver metastases (CRLM) may offer good long-term survival. The impact of the tumor-free surgical margin on long-term results remains controversial, and we have assessed this component in 185 patients.
Methods. Between 1992 and 2005, 185 patients underwent primary hepatectomy with curative intent for CRLM (which originated from colon/rectum 133/52, synchronous/melachronous 66/119, and single/multiple 100/85). In this study, 105 major and 80 minor hepatectomies were evaluated; 133 hepatectomies had pedicle clamping.
Results. Operative mortality was 1.1%, morbidity was 25.7%, and blood transfusion requirement was 27.6%. Stratification of tumor-free margin in the patients with R0 liver resection was greater than or equal to 10 mm (63.0% of patients), 6-9 mm (11.4% of patients), 3-5 mm (16.5% of patients), and less than or equal to 2 mm (9.1% of patients), with infiltrated margin in the remainder (R1 liver resection 4.9% of the total number of patients). The 3-year, 5-year, and 10-year survival rates were 54.9%, 37.9%, and 22.9%, respectively. Global and surgical margin recurrence rates increased as the tumor-free margin decreased (P =. 01 and P <. 001, respectively). At univariate analysis, the width of surgical margin (P <. 001), transfusion requirement, major hepatectomy, RI resection, number of metastases, high Preoperative CEA, and increasing tumor size (P value from. 001 to. 03) were associated with lesser rates of long-term survival. A similar association was found with disease free survival. At multivariate analysis, width of surgical margin was the only independent predictor of both overall (P =. 003) and disease free (P <. 001) survival. Although smaller margins were associated with synchronicity, increasing number of, and with bilobar distribution of, metastases which contributed to explaine recurrences away from the margin), the width of surgical margin maintained the prominent impact on outcome.
Conclusions. In our patients, the width of the surgical. margin was a powerful prognostic factor after hepatectomy for CRLM. A resection margin less than or equal to 5 mm was associated with a greater risk of recurrence on the surgical margin, with a lesser rate of overall and disease free survival.
KW - Blood transfusion
KW - Liver ischemia
KW - Liver metastases
KW - Liver resection
KW - Overall survival
KW - Surgical free-margin
KW - Tumor recurrence
KW - Blood transfusion
KW - Liver ischemia
KW - Liver metastases
KW - Liver resection
KW - Overall survival
KW - Surgical free-margin
KW - Tumor recurrence
UR - http://hdl.handle.net/10807/14401
U2 - 10.1016/j.surg.2007.09.038
DO - 10.1016/j.surg.2007.09.038
M3 - Article
SN - 0039-6060
VL - 143
SP - 384
EP - 393
JO - Surgery
JF - Surgery
ER -