Published in:
01-05-2010 | Hepatobiliary and Pancreatic Tumors
Resection Margin and Recurrence-Free Survival After Liver Resection of Colorectal Metastases
Published in: Annals of Surgical Oncology | Issue 5/2010
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Background
Optimal margin width is uncertain because of conflicting results from recent studies using overall survival as the end-point. After recurrence, re-resection and aggressive chemotherapy heavily affect survival time; the potential confounding effect of such factors has not been investigated. Use of recurrence-free survival (RFS) may overcome this limitation. The aim of this study is to evaluate the impact of width of resection margin on RFS and site of recurrence after hepatic resection for colorectal metastases (CRM).
Methods
From a prospectively maintained institutional database (1/1999–12/2007) we identified 314 patients undergone hepatectomy for CRM (1/1999–12/2007) with detailed pathologic analysis of the surgical margin and complete follow-up imaging studies documenting disease status and site of recurrence, which was categorized as: resection margin (Marg), other intra-hepatic (otherIH), lung (L) or other extra-hepatic (otherEH). Recurrence-free estimation was the survival end-point.
Results
Median follow-up was 56.5 months. Two hundred and fifteen patients (68.8%) recurred at 288 sites after a mean of 15.5 months. A positive resection margin was associated with an increased risk of Marg recurrence (P < 0.001). The presence of ≥2 metastases was the only factor increasing the risk of positive margins (P < 0.05). The width of the negative resection margin (≥1 cm versus >1 cm) was not a prognostic factor of worse RFS (30.2% versus 37.3%, P = 0.6). Node status of the primary tumour, and size and number of CRM were independent predictors of RFS.
Conclusions
Tumour biology and not the width of the negative resection margin affect RFS.