Effect of Surgical Margin Status on Survival and Site of Recurrence After Hepatic Resection for Colorectal Metastases
Top Cited Papers
- 1 May 2005
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Annals of Surgery
- Vol. 241 (5), 715-724
- https://doi.org/10.1097/01.sla.0000160703.75808.7d
Abstract
To evaluate the influence of surgical margin status on survival and site of recurrence in patients treated with hepatic resection for colorectal metastases. Using a multicenter database, 557 patients who underwent hepatic resection for colorectal metastases were identified. Demographics, operative data, pathologic margin status, site of recurrence (margin, other intrahepatic site, extrahepatic), and long-term survival data were collected and analyzed. On final pathologic analysis, margin status was positive in 45 patients, and negative by 1 to 4 mm in 129, 5 to 9 mm in 85, and > or =1 cm in 298. At a median follow-up of 29 months, the 1-, 3-, and 5-year actuarial survival rates were 97%, 74%, and 58%; median survival was 74 months. Tumor size > or =5 cm, >3 tumor nodules, and carcinoembryonic antigen level >200 ng/mL predicted poor survival (all P < 0.05). Median survival was 49 months in patients with positive margins and not yet reached in patients with negative margins (P = 0.01). After hepatic resection, 225 (40.4%) patients had recurrence: 21 at the surgical margin, 56 at another intrahepatic site, 82 at an extrahepatic site, and 66 at both intrahepatic and extrahepatic sites. Patients with negative margins of 1 to 4 mm, 5 to 9 mm, and > or =1 cm had similar overall recurrence rates (P > 0.05). Patients with positive margins were more likely to have surgical margin recurrence (P = 0.003). Adverse preoperative biologic factors including tumor number greater than 3 (P = 0.01) and a preoperative CEA level greater than 200 ng/mL (P = 0.04) were associated with an increased risk of positive surgical margin. A positive margin after resection of hepatic colorectal metastases is associated with adverse biologic factors and increased risk of surgical-margin recurrence. The width of a negative surgical margin does not affect survival, recurrence risk, or site of recurrence. A predicted margin of <1 cm after resection of hepatic colorectal metastases should not be used as an exclusion criterion for resection.Keywords
This publication has 43 references indexed in Scilit:
- Tumor Progression While on ChemotherapyAnnals of Surgery, 2004
- Rescue Surgery for Unresectable Colorectal Liver Metastases Downstaged by ChemotherapyAnnals of Surgery, 2004
- Saline-Linked Surface Radiofrequency AblationAnnals of Surgery, 2004
- Protection of the liver during hepatic surgeryJournal of Gastrointestinal Surgery, 2004
- Perioperative complications in patients undergoing major liver resection with or without neoadjuvant chemotherapyJournal of Gastrointestinal Surgery, 2003
- The Brisbane 2000 Terminology of Liver Anatomy and Resections. HPB 2000; 2:333‐39HPB, 2002
- Long-term results of treating hepatic colorectal metastases with cryosurgeryBritish Journal of Surgery, 2001
- Five-Year Survival Following Hepatic Resection After Neoadjuvant Therapy for Nonresectable Colorectal [Liver] MetastasesAnnals of Surgical Oncology, 2001
- Analysis of prognostic risk factors in hepatic resection for metastatic colorectal carcinoma with special reference to the surgical marginBritish Journal of Surgery, 1997
- Resection of colorectal liver metastasesWorld Journal of Surgery, 1995