Influence of Margins on Disease Free Survival Following Hepatic Resection for Colorectal Metastasis: A Meta-Analysis

The aim of our study was to conduct a meta-analysis of reports published on hepatic resection for colorectal liver metastases (CRLM) and determine if a negative margin ≥1 cm confers a disease free survival (DFS) advantage over sub-centimeter negative margins. The 357 initially selected articles were screened to identify 90 articles of interest of which eleven were finally included in the meta-analysis. Patients with positive margins were excluded from the meta-analysis. Meta-analysis was performed using STATA 9.2 statistical software. A total of 1,989 patients with negative margins from the eleven studies were included in the meta-analysis. The 5-year DFS for all patients was 27.9 % (95 % CI 23.5 % to 32.2 %). The 5-year DFS for ≥1 cm negative margin subgroup was 34.4 % (95 % CI 27.97 % to 40.7 %) when compared to 21.0 % (95 % CI 17.4 % to 24.7 %) for <1 cm negative margin subgroup. The odds ratio for ≥1 cm negative margins was found to be 0.552 (95 % CI 0.408 to 0.747, p < 0.001) when compared to <1 cm negative margins. The results of this meta-analysis demonstrate that in patients undergoing hepatic resection for CRLM, a negative margin ≥ 1 cm may confer a better DFS compared with a sub-centimeter negative margin.