Top

Published in:

01-03-2018 | Original Scientific Report

Margin Status is Still an Important Prognostic Factor in Hepatectomies for Colorectal Liver Metastases: A Propensity Score Matching Analysis

Authors: Riccardo Memeo, Vito de Blasi, Rene Adam, Diane Goéré, Tullio Piardi, Emilie Lermite, Olivier Turrini, Francis Navarro, Nicola de’Angelis, Antonio Sa Cunha, Patrick Pessaux, French Colorectal Liver Metastases Working Group, Association Française de Chirurgie (AFC)

Published in: World Journal of Surgery | Issue 3/2018

Abstract

Objective

The width of resection margin is still a matter of debate in case of colorectal liver metastasis resection. The aim of this study was to determine the risk factors for R1 resection. Once risk factors had been identified, patients were matched according to Fong’s prognostic criteria, in order to evaluate whether R1 resection still remained a negative prognostic factor impacting overall and disease-free survival.

Methods

A total of 1784 hepatectomies were analyzed from a multicentric retrospective cohort of hepatectomies. Patients were compared before and after a 1:1 propensity score analysis in order to compare R0 versus R1 resections according to Fong criteria.

Results

Primary tumor nodes found positive after colorectal resection (RR = 1.20, p = 0.02), operative time (> 240 min) (RR = 1.26, p = 0.05), synchronous liver metastasis (RR = 1.27, p = 0.02), pedicle clamping (> 40 min) (RR = 1.52, p = 0.001), lesion size larger than 50 mm (RR = 1.54, p = 0.001), rehepatectomy (RR = 1.68, p = 0.001), more than 3 lesions (RR = 1.69, p = 0.0001), and bilateral lesions (RR = 1.74, p = 0.0001) were identified as risk factors in multivariate analysis. After a 1:1 PSM according to Fong criteria, R1 resection still remained a negative prognostic factor impacting overall and disease-free survival, with 1-, 3-, 5-year OS at 94, 81, and 70% in R0 and 92, 75, and 58% in R1, respectively, (p = 0.008), and disease-free survival (DFS) with 1-, 3-, 5-year survival at 64, 41, and 28% in R0 versus 51, 28, and 18% in R1 (p = 0.0002), respectively.

Conclusion

Even after using PSM as an oncological prognostic criterion, R1 resection still impacts overall and disease-free survival negatively.

Hamady ZZR, Lodge JPA, Welsh FK et al (2014) One-millimeter cancer-free margin is curative for colorectal liver metastases. Ann Surg 259:543–548. doi:10.1097/SLA.0b013e3182902b6e CrossRefPubMed

Strasberg SM, Phillips C (2013) Use and dissemination of the brisbane 2000 nomenclature of liver anatomy and resections. Ann Surg 257:377–382. doi:10.1097/SLA.0b013e31825a01f6 CrossRefPubMed

Sadot E, Koerkamp BG, Leal JN et al (2015) Resection margin and survival in 2368 patients undergoing hepatic resection for metastatic colorectal cancer. Ann Surg 262:476–485. doi:10.1097/SLA.0000000000001427 CrossRefPubMedPubMedCentral

Pandanaboyana S, White A, Pathak S et al (2015) Impact of margin status and neoadjuvant chemotherapy on survival, recurrence after liver resection for colorectal liver metastasis. Ann Surg Oncol 22:173–179. doi:10.1245/s10434-014-3953-6 CrossRefPubMed

Nuzzo G, Giuliante F, Ardito F et al (2008) Influence of surgical margin on type of recurrence after liver resection for colorectal metastases: a single-center experience. Surgery 143:384–393. doi:10.1016/j.surg.2007.09.038 CrossRefPubMed

Elias D, Cavalcanti A, Sabourin JC et al (1998) Results of 136 curative hepatectomies with a safety margin of less than 10 mm for colorectal metastases. J Surg Oncol 69:88–93CrossRefPubMed

Liu W, Sun Y, Zhang L, Xing B (2015) Negative surgical margin improved long-term survival of colorectal cancer liver metastases after hepatic resection: a systematic review and meta-analysis. Int J Colorectal Dis. doi:10.1007/s00384-015-2323-6

Fong Y, Fortner J, Sun RL et al (1999) Clinical score for predicting recurrence after hepatic resection for metastatic colorectal cancer: analysis of 1001 consecutive cases. Ann Surg 230:309–321. doi:10.1097/00000658-199909000-00004 CrossRefPubMedPubMedCentral

Nordlinger B, Sorbye H, Glimelius B et al (2013) Perioperative FOLFOX4 chemotherapy and surgery versus surgery alone for resectable liver metastases from colorectal cancer (EORTC 40983): long-term results of a randomised, controlled, phase 3 trial. Lancet Oncol 14:1208–1215. doi:10.1016/S1470-2045(13)70447-9 CrossRefPubMed

10.

Welsh FKS, Tekkis PP, O’Rourke T et al (2008) Quantification of risk of a positive (R1) resection margin following hepatic resection for metastatic colorectal cancer: an aid to clinical decision-making. Surg Oncol 17:3–13. doi:10.1016/j.suronc.2007.12.003 CrossRefPubMed

11.

Poultsides GA, Schulick RD, Pawlik TM (2010) Hepatic resection for colorectal metastases: the impact of surgical margin status on outcome. HPB (Oxf) 12:43–49. doi:10.1111/j.1477-2574.2009.00121.x CrossRef

12.

Dematteo RP, Palese C, Jarnagin WR et al (2000) Anatomic segmental hepatic resection is superior to wedge resection as an oncologic operation for colorectal liver metastases. J Gastrointest Surg 4:178–184CrossRefPubMed

13.

Wray CJ, Lowy AM, Mathews JB et al (2005) The significance and clinical factors associated with a subcentimeter resection of colorectal liver metastases. Ann Surg Oncol 12:374–380. doi:10.1245/ASO.2005.06.038 CrossRefPubMed

14.

Zorzi D, Mullen JT, Abdalla EK et al (2006) Comparison between hepatic wedge resection and anatomic resection for colorectal liver metastases. J Gastrointest Surg 10:86–94. doi:10.1016/j.gassur.2005.07.022 CrossRefPubMed

15.

Puglisi F, Capuano P, Iambrenghi OC et al (2009) Laparoscopic repair of Morgagni hernia in an adult: use of a porcine small intestine submucosa biocompatible prosthesis. Chir Ital 61:351–356PubMed

16.

de’Angelis N, Memeo R, Calderaro J et al (2014) Open and laparoscopic resection of hepatocellular adenoma: trends over 23 years at a specialist hepatobiliary unit. HPB (Oxf) 16:783–788. doi:10.1111/hpb.12257 CrossRef

17.

Memeo R, de’Angelis N, Compagnon P et al (2014) Laparoscopic vs. open liver resection for hepatocellular carcinoma of cirrhotic liver: a case-control study. World J Surg 38:2919–2926. doi:10.1007/s00268-014-2659-z CrossRefPubMed

18.

Salloum C, Subar D, Memeo R et al (2013) Laparoscopic robotic liver surgery: the Henri Mondor initial experience of 20 cases. J Robot Surg. doi:10.1007/s11701-013-0437-9 PubMed

19.

Ali MA, Di Sandro S, Lauterio A et al (2015) Repeat hepatectomy for recurrent colorectal liver metastases: is it worth the challenge? J Gastrointest Surg 19:2192–2198. doi:10.1007/s11605-015-2939-4 CrossRefPubMed

20.

Sjoquist KM, Burmeister BH, Smithers BM et al (2011) Survival after neoadjuvant chemotherapy or chemoradiotherapy for resectable oesophageal carcinoma: an updated meta-analysis. Lancet Oncol 12:681–692. doi:10.1016/S1470-2045(11)70142-5 CrossRefPubMed

21.

Markar SR, Bodnar A, Rosales J et al (2013) The impact of neoadjuvant chemoradiotherapy on perioperative outcomes, tumor pathology, and survival in clinical stage II and III esophageal cancer. Ann Surg Oncol 20:3935–3941. doi:10.1245/s10434-013-3137-9 CrossRefPubMed

22.

Memeo R, de’Angelis N, de Blasi V, Cherkaoui Z, Brunetti O, Longo V, Piardi T, Sommacale D, Marescaux J, Mutter D, Pessaux P (2016) Innovative surgical approaches for hepatocellular carcinoma. World J Hepatol 8:591–596. doi:10.5662/wjm.v1.i1.4 CrossRefPubMedPubMedCentral

23.

Ntourakis D, Memeo R, Soler L et al (2015) Augmented reality guidance for the resection of missing colorectal liver metastases: an initial experience. World J Surg. doi:10.1007/s00268-015-3229-8 PubMed

Title: Margin Status is Still an Important Prognostic Factor in Hepatectomies for Colorectal Liver Metastases: A Propensity Score Matching Analysis
Authors: Riccardo Memeo
Vito de Blasi
Rene Adam
Diane Goéré
Tullio Piardi
Emilie Lermite
Olivier Turrini
Francis Navarro
Nicola de’Angelis
Antonio Sa Cunha
Patrick Pessaux
French Colorectal Liver Metastases Working Group, Association Française de Chirurgie (AFC)
Publication date: 01-03-2018
Publisher: Springer International Publishing
Published in: World Journal of Surgery / Issue 3/2018
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI: https://doi.org/10.1007/s00268-017-4229-7

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Margin Status is Still an Important Prognostic Factor in Hepatectomies for Colorectal Liver Metastases: A Propensity Score Matching Analysis

Abstract

Objective

Methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Objective

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 3/2018

Perioperative Mortality Following Oesophagectomy and Pancreaticoduodenectomy in Australia

Trauma to the Superior Mesenteric Artery and Superior Mesenteric Vein: A Narrative Review of Rare but Lethal Injuries

Cohort Contributions to Race- and Gender-Specific Trends in the Incidence of Hepatocellular Carcinoma in the USA

Compartment Pressure Monitoring After Thyroid Surgery: A Possible Method to Detect a Rebleeding

Minimally Invasive Pancreaticoduodenectomy: What is the Best “Choice”? A Systematic Review and Network Meta-analysis of Non-randomized Comparative Studies

Recovery of Voice After Reconstruction of the Recurrent Laryngeal Nerve and Adjuvant Nimodipine