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World Journal of Surgical Oncology

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Open Access 01-12-2014 | Research

Surgery for colorectal liver metastases: the impact of resection margins on recurrence and overall survival

Authors: Jon-Helge Angelsen, Arild Horn, Geir Egil Eide, Asgaut Viste

Published in: World Journal of Surgical Oncology | Issue 1/2014

Abstract

Background

Several reports have presented conflicting results regarding the association between resection margins (RMs) and outcome after surgery for colorectal liver metastases (CLM), especially in the era of modern chemotherapy. The purpose of this study was to evaluate the impact of RMs on overall survival (OS), time to recurrence (TTR) and local recurrence (LR) status, particularly for patients treated with preoperative chemotherapy.

Methods

A combined retrospective (1998 to 2008) and prospective (2008 to 2010) cohort study of consecutive patients with CLM without extrahepatic disease treated with primary resection at a medium volume centre.

Results

A total of 253 patients with known R status and 242 patients with defined margin width were included in the study. Patients were stratified according to margin width; A: R1, <1 mm (n = 48, 19%), B: 1 to 4 mm (n = 77), C: 5 to 9 mm (n = 46) and D: ≥10 mm (n = 71). Median time to recurrence was 12.8 months, and after five years 21.5% had no recurrence. LR (inclusive combined recurrence in other hepatic sites or extrahepatic) occurred in 40 (16.5%) cases, most frequently seen with RMs below 5 mm. Five-year OS was 42.5% in R0 and 16.1% in R1 resections (P = 0.011). Patients were also stratified according to preoperative chemotherapy (n = 88), and the difference in five-year OS between R0 (45.1%) and R1 (14.7%) was maintained (P = 0.037). By multiple Cox regression analysis R1 resections tended to an adverse outcome (P = 0.067), also when adjusting for preoperative chemotherapy (P = 0.081).

Conclusions

R1 resections for colorectal liver metastases predict adverse outcome. RMs below 5 mm increased the risk for LR and shortened the time to recurrence. Preoperative chemotherapy did not alter an adverse outcome in R1 vs. R0 patients.

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Title: Surgery for colorectal liver metastases: the impact of resection margins on recurrence and overall survival
Authors: Jon-Helge Angelsen
Arild Horn
Geir Egil Eide
Asgaut Viste
Publication date: 01-12-2014
Publisher: BioMed Central
Published in: World Journal of Surgical Oncology / Issue 1/2014
Electronic ISSN: 1477-7819
DOI: https://doi.org/10.1186/1477-7819-12-127

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Surgery for colorectal liver metastases: the impact of resection margins on recurrence and overall survival

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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