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International Journal of Colorectal Disease
Published in: International Journal of Colorectal Disease 10/2015

01-10-2015 | Original Article

Negative surgical margin improved long-term survival of colorectal cancer liver metastases after hepatic resection: a systematic review and meta-analysis

Authors: Wei Liu, Yi Sun, Lei Zhang, Bao-Cai Xing

Published in: International Journal of Colorectal Disease | Issue 10/2015

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Abstract

Objective

The need to achieve a tumor-free margin of ≥1 mm (R0) for colorectal liver metastases (CRLM) after hepatic resection has been questioned recently. This study conducted a meta-analysis to determine whether status of the surgical margin still influenced the long-term outcome of survival and recurrence rate.

Methods

Eligible trials that compared survival and recurrence rates of R0 versus the tumor-free margin <1 mm (R1) were identified from Embase, PubMed, the Web of Science, and the Cochrane Library since their inception to 1 March 2015. The study outcomes included long-term outcome of survival and recurrence rate. Hazard ratio (HR) with a 95 % confidence interval was used to measure the pooled effect according to a random-effects model or fixed-effects model, depending on the heterogeneity among the included studies. The heterogeneity among these trials was statistically evaluated using the χ 2 and I 2 tests. Sensitivity analyses and publication bias were also carried out.

Results

A total of 18 studies containing 6790 patients were included. The comparison between R1 and R0 revealed that a pooled HR for 5-year overall survival was 1.603 (95 % CI; 1.464–1.755; p = 0.000; I 2 = 31.2 %, p = 0.141). For patients received modern chemotherapy; a pooled HR of R1 resection for 5-year overall survival was 1.924 (95 % CI; 1.567–2.361, p = 0.000; I 2 = 20.5 %, p = 0.273). The pooled HR for 5-year OS of ≥1 cm in the included studies calculated using the random-effects model was 0.819 (95 % CI; 0.715–0.938, p = 0.004; I 2 = 0 %, p = 0.492).

Conclusions

R1 resections decreased long-term survival, and modern chemotherapy did not alter an adverse outcome. Surgeons should attempt to obtain a 1-cm margin.
Appendix
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Metadata
Title
Negative surgical margin improved long-term survival of colorectal cancer liver metastases after hepatic resection: a systematic review and meta-analysis
Authors
Wei Liu
Yi Sun
Lei Zhang
Bao-Cai Xing
Publication date
01-10-2015
Publisher
Springer Berlin Heidelberg
Published in
International Journal of Colorectal Disease / Issue 10/2015
Print ISSN: 0179-1958
Electronic ISSN: 1432-1262
DOI
https://doi.org/10.1007/s00384-015-2323-6

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