Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 6/2016

01-06-2016 | Hepatobiliary Tumors

Long-Term Survival Benefit and Potential for Cure after R1 Resection for Colorectal Liver Metastases

Authors: Isamu Hosokawa, MD, PhD, Marc-Antoine Allard, MD, Maximiliano Gelli, MD, Oriana Ciacio, MD, Eric Vibert, MD, PhD, Daniel Cherqui, MD, Antonio Sa Cunha, MD, Denis Castaing, MD, Masaru Miyazaki, MD, PhD, René Adam, MD, PhD

Published in: Annals of Surgical Oncology | Issue 6/2016

Login to get access

Abstract

Background

Although efficient chemotherapy regimens have improved outcomes after R1 resection (positive margins) for colorectal liver metastases (CLMs), the long-term survival benefit and potential for cure after R1 resection have not been clearly demonstrated. The aim of this study was to evaluate the long-term outcome after R1 resection for CLM, and to identify factors predictive of cure.

Methods

All resected CLM patients at our institution from 2000 to 2009 were prospectively evaluated. Cure was defined as a disease-free interval ≥5 years from the last hepatic or extrahepatic resection to last follow-up.

Results

Of 628 patients consecutively resected for CLM, 428 were eligible for the study, of whom 219 (51 %) underwent R0 resection (negative margins) and 209 (49 %) underwent R1 resection. Overall, 130 patients with R0 resection and 141 patients with R1 resection had more than 5 years of follow-up. Five- and 10-year overall survival rates were 56 and 34 % for R0 patients, and 48 and 36 % for R1 patients, respectively (p = 0.37). Of the 141 patients who underwent R1 resection, 26 patients (18 %) were considered ‘cured’, and 106 patients (75 %) were considered ‘noncured’. Independent predictive factors of cure after R1 resection included ≤10 total cycles of preoperative chemotherapy and objective response to preoperative chemotherapy.

Conclusions

Overall, potential cure can be achieved in 18 % of patients after R1 resection for CLM. The best conditions to achieve long-term survival after R1 resection rely on a good response to efficient and short first-line chemotherapy.
Appendix
Available only for authorised users
Literature
1.
de Hass RJ, Wicherts DA, Flores E, et al. R1 resection by necessity for colorectal liver metastases: is it still a contraindication to surgery? Ann Surg. 2008;248:626–37.
2.
Ekberg H, Tranberg KG, Andersson R, et al. Determinants of survival in liver resection for colorectal secondaries. Br J Surg. 1986;73:727–31.CrossRefPubMed
3.
Shirabe K, Takenaka K, Gion T, et al. Analysis of prognostic risk factors in hepatic resection for metastatic colorectal carcinoma with special reference to the surgical margin. Br J Surg. 1997;84:1077–80.CrossRefPubMed
4.
Cady B, Jenkins RL, Steele GD Jr, et al. Surgical margin in hepatic resection for colorectal metastasis: a critical and improvable determinant of outcome. Ann Surg. 1998;227:566–71.CrossRefPubMedPubMedCentral
5.
Ng JK, Urbanski SJ, Mangat N, et al. Colorectal liver metastases contact centripetally with a response to chemotherapy: a histomorphologic study. Cancer. 2008;112:362–71.CrossRefPubMed
6.
Kokudo N, Miki Y, Sugai S, et al. Genetic and histological assessment of surgical margins in resected liver metastases from colorectral carcinoma: minimum surgical margins for successful resection. Arch Surg. 2002;137:833–40.CrossRefPubMed
7.
Pawlik TM, Scoggins CR, Zorzi D, et al. Effect of surgical margin status on survival and site of recurrence after hepatic resection for colorectal metastases. Ann Surg. 2005;241:715–24.CrossRefPubMedPubMedCentral
8.
Andreou A, Aloia T, Brouquet A, et al. Margin status remains an important determinant of survival after surgical resection of colorectal liver metastases in the era of modern chemotherapy. Ann Surg. 2013;257:1079–88.CrossRefPubMedPubMedCentral
9.
Margonis GA, Spolverato G, Kim Y, et al. Intraoperative surgical margin re-resection for colorectal liver metastasis: is it worth the effort? J Gastrointest Surg. 2015;13:872–80.
10.
Tranchart H, Chirica M, Faron M, et al. Prognostic impact of positive surgical margins after resection of colorectal cancer liver metastases: reappraisal in the era of modern chemotherapy. World J Surg. 2013;37:2647–54.CrossRefPubMed
11.
12.
Schadde E, Ardiles V, Robles-Campos R, et al. Early survival and safety of ALPPS: first report of the international ALPPS registry. Ann Surg. 2014;260:829–38.CrossRefPubMed
13.
Adam R, de Hass RJ, Wicherts DA, et al. Concomitant extrahepatic disease in patients with colorectal liver metastases: when is there a place for surgery? Ann Surg. 2011;253:349–59.CrossRefPubMed
14.
Adam R, Pascal G, Castaing D, et al. Tumor progression while on chemotherapy: a contraindication to liver resection for multiple colorectal metastases? Ann Surg. 2004;240:1052–61.CrossRefPubMedPubMedCentral
15.
Adam R, Delvart V, Pascal G, et al. Rescue surgery for unresectable colorectal liver metastases downstaged by chemotherapy: a model to predict long-term survival. Ann Surg. 2004;240:644–57.CrossRefPubMedPubMedCentral
16.
Adam R, Hoti E, Bredt LC, et al. Evolution of neoadjuvant therapy for extended hepatic metastases: have we reached our (non-resectable) limit? J Surg Oncol. 2010;102:922–31.CrossRefPubMed
17.
Adam R, de Gramont A, Figueras J, et al. The oncosurgery approach to managing liver metastases from colorectal cancer: a multidisciplinary international consensus. Oncologist. 2012;17:1225–39.CrossRefPubMedPubMedCentral
18.
Therasse P, Arbuck SG, Eisenhauer EA, et al. New guidelines to evaluate the response to treatment in solid tumors. European Organization for Research and Treatment of Cancer, National Cancer Institute of the United States, National Cancer Institute of Canada. J Natl Cancer Inst. 2000;92:205–16.CrossRefPubMed
19.
Eisenhauer EA, Therasse P, Bogaerts J, et al. New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1). Eur J Cancer. 2009;45:228–47.CrossRefPubMed
20.
Adam R, Wicherts DA, de Haas RJ, et al. Patients with initially unresectable colorectal liver metastases: is there a possibility of cure? J Clin Oncol. 2009;27:1829–35.CrossRefPubMed
21.
Goere D, Malka D, Tzanis D, et al. Is there a possibility of a cure in patients with colorectal peritoneal carcinomatosis amenable to complete cytoreductive surgery and intraperitoneal chemotherapy? Ann Surg. 2013;257:1065–71.CrossRefPubMed
22.
Sadot E, Koerkamp BG, Leal JN, et al. Resection margin and survival in 2368 patients undergoing hepatic resection for metastatic colorectal cancer: surgical technique of biologic surrogate? Ann Surg. 2015;262:476–85.CrossRefPubMed
23.
Hamady ZZ, Lodge JP, Welsh FK, et al. One-millimeter cancer-free margin is curative for colorectal liver metastases: a propensity score case-match approach. Ann Surg. 2014;259:543–8.CrossRefPubMed
24.
Viagnò L, Capussotti L, Barroso E, et al. Progression while receiving preoperative chemotherapy should not be an absolute contraindication to liver resection for colorectal metastases. Ann Surg Oncol. 2012;19:2786–96.CrossRef
25.
Tomlinson JS, Jarnagin WR, DeMatteo RP, et al. Actual 10-year survival after resection of colorectal liver metastases define cure. J Clin Oncol. 2007;25:4575–80.CrossRefPubMed
Metadata
Title
Long-Term Survival Benefit and Potential for Cure after R1 Resection for Colorectal Liver Metastases
Authors
Isamu Hosokawa, MD, PhD
Marc-Antoine Allard, MD
Maximiliano Gelli, MD
Oriana Ciacio, MD
Eric Vibert, MD, PhD
Daniel Cherqui, MD
Antonio Sa Cunha, MD
Denis Castaing, MD
Masaru Miyazaki, MD, PhD
René Adam, MD, PhD
Publication date
01-06-2016
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology / Issue 6/2016
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-015-5060-8

Other articles of this Issue 6/2016

Annals of Surgical Oncology 6/2016 Go to the issue

Pancreatic Tumors

Pancreatectomy with Mesenteric and Portal Vein Resection for Borderline Resectable Pancreatic Cancer: Multicenter Study of 406 Patients

Thoracic Oncology

A Population-Based Cost Analysis of Thoracoscopic Versus Open Lobectomy in Primary Lung Cancer

Healthcare Policy and Outcomes

Factors Associated with Short-Term Mortality After Surgical Oncologic Emergencies

Breast Oncology

Intraoperative Radiation Therapy in Breast Cancer: Still Not Ready for Prime Time

Hepatobiliary Tumors

CD133 Expression at the Metastatic Site Predicts Patients’ Outcome in Colorectal Cancer with Synchronous Liver Metastasis

Gastrointestinal Oncology

Splenectomy Increases Postoperative Complications Following Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy