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Surgical Endoscopy
Published in: Surgical Endoscopy 9/2015

01-09-2015

Impact of surgical margins on overall and recurrence-free survival in parenchymal-sparing laparoscopic liver resections of colorectal metastases

Authors: Roberto Montalti, Federico Tomassini, Stéphanie Laurent, Peter Smeets, Marc De Man, Karen Geboes, Louis J. Libbrecht, Roberto I. Troisi

Published in: Surgical Endoscopy | Issue 9/2015

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Abstract

Background

The relationship between the width of surgical margins and local and distant recurrence of colorectal liver metastases (CRLM) remain controversial. We analyzed the impact of surgical margins in laparoscopic liver resections (LLR) for CRLM, using the parenchymal-sparing approach on overall (OS) and recurrence-free survival (RFS).

Methods

From January 2005 to October 2012, 114 first LLR for CRLM were performed and retrospectively analyzed. The ultrasonic aspirator was used for parenchyma division. R1 margins were defined when the tissue width was <1 mm.

Results

After a mean follow-up of 30.9 ± 1.71 months, OS was 97.1–73.9–58.9 % and the RFS 64.2–35.2–31 % at 1–3–5 years, respectively. The major resection rate was 7 %. The median margin width was 3 (0–40) mm, and R1 resection was recorded in 14 (12.3 %) cases. Twenty-two patients (33.3 %) with hepatic recurrence underwent a repeat hepatectomy. R1 margins were significantly related to lower RFS survival (p = 0.038) but did not affect OS. Multivariate analysis showed that lesions located in postero-superior segments (HR = 2.4, 95 % CI 1.24–4.61, p = 0.009) as well as blood loss (HR = 3.2, 95 % CI 1.23–7.99, p = 0.012) were independent risk factors for tumor recurrence. The carcinoembryonic antigen level >10 mcg/L affected OS (HR = 4.2 95 % CI 2.02–16.9, p = 0.001), and the resection of more than two tumors was significantly associated with R1 margins (HR = 9.32, 95 % CI 1.14–32.5, p = 0.037).

Discussion

Laparoscopic parenchymal-sparing surgery of CRLM does not compromise the oncological outcome, allowing a higher percentage of repeat hepatectomy. R1 margins are a risk factor for tumor recurrence but not for overall survival. The presence of multiple lesions is the only independent risk factor of R1 margins and also the major disadvantage of this technique.
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Metadata
Title
Impact of surgical margins on overall and recurrence-free survival in parenchymal-sparing laparoscopic liver resections of colorectal metastases
Authors
Roberto Montalti
Federico Tomassini
Stéphanie Laurent
Peter Smeets
Marc De Man
Karen Geboes
Louis J. Libbrecht
Roberto I. Troisi
Publication date
01-09-2015
Publisher
Springer US
Published in
Surgical Endoscopy / Issue 9/2015
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-014-3999-3

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