Hepatic resection for colorectal metastases: The impact of surgical margin status on outcome

Department of Surgery, Johns Hopkins Medical Institutions, 600 North Wolfe Street, Baltimore, MD 21287, USA.
HPB (Impact Factor: 2.68). 02/2010; 12(1):43-9. DOI: 10.1111/j.1477-2574.2009.00121.x
Source: PubMed


An R0 margin width of 1 cm has traditionally been considered a prerequisite to minimize local recurrence and optimize survival following hepatic resection for metastatic colorectal cancer. However, recent data have called into question the prognostic importance of the '1-cm rule'. Specifically, several studies have noted that, although an R0 resection is important, the actual margin width may not be as critical. We provide a brief overview of the impact of an R1 vs. an R0 resection on local recurrence and overall survival. In addition, we specifically review the impact of margin width in patients who have undergone an R0 resection. Finally, we highlight those factors most associated with an increased likelihood of an R1 resection and provide recommendations for avoiding and dealing with microscopic carcinoma discovered intraoperatively at the cut parenchymal transection margin.

Download full-text


Available from: Timothy M Pawlik,
  • Source
    • "In our study, we demonstrated in both univariate and multivariate analyses that the 5-year OS for patients without neoadjuvant chemotherapy showed a marked difference between R0 and R1 resection. Others proposed that margin widths of 2 and 5 mm, respectively, were acceptable and led to similar outcomes compared with 1-cm margin resection.28,29,46 We also analyzed whether margin width ≤2 mm or >2 mm influenced survival. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Data from patients with colorectal liver metastases (CRLM) who received neoadjuvant chemotherapy before resection were reviewed and evaluated to see whether neoadjuvant chemotherapy influences the predictive outcome of R1 resections (margin is 0 mm) in patients with CRLM. Between January 2000 and December 2008, all consecutive patients undergoing liver resection for CRLM were analyzed. Patients were divided into those who did and did not receive neoadjuvant chemotherapy. The outcome after R0 (tumor-free margin >0 mm) and R1 (tumor-free margin 0 mm) resection was compared. A total of 264 were eligible for analysis. Median follow-up was 34 months. Patients without chemotherapy showed a significant difference in median disease-free survival (DFS) after R0 or R1 resection: 17 [95% confidence interval (CI) 10-24] months versus 8 (95% CI 4-12) months (P < 0.001), whereas in patients with neoadjuvant chemotherapy the difference in DFS between R0 and R1 resection was not significant: 18 (95% CI 10-26) months versus 9 (95% CI 0-20) months (P = 0.303). Patients without chemotherapy showed a significant difference in median overall survival (OS) after R0 or R1 resection: 53 (95% CI 40-66) months versus 30 (95% CI 13-47) months (P < 0.001). In patients with neoadjuvant chemotherapy, the median OS showed no significant difference: 65 (95% CI 39-92) months for the R0 group versus the R1 group, in whom the median OS was not reached (P = 0.645). In patients treated with neoadjuvant chemotherapy, R1 resection was of no predictive value for DFS and OS.
    Annals of Surgical Oncology 10/2011; 19(5):1618-27. DOI:10.1245/s10434-011-2114-4 · 3.93 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Focal liver and pancreatic lesions represent important therapeutic problem in a relatively huge group of patients. Secondary liver tumors are the crucial factor affecting morbidity and mortality in patients with malignancies. Radical surgery is the only therapeutic option that gives the chance of long-term survival. The authors present current trends in surgical therapy of liver and pancreatic tumors as a review article.
    Vnitr̆ní lékar̆ství 04/2011; 57(4):356-63.
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: To assess the oncological efficiency of laparoscopic minor and major hepatectomy for primary and metastatic liver malignant neoplasms. Retrospective single-center study. Tertiary university hospital. One hundred twenty-eight patients undergoing 133 laparoscopic liver resections for malignant diseases. Perioperative results and midterm overall and disease-free survival. Surgical indications were colorectal carcinoma liver metastasis (n = 83), hepatocellular carcinoma (n = 18), neuroendocrine tumor metastasis (n = 17), non-colorectal carcinoma liver metastasis (n = 11), lymphoma (n = 2), and intrahepatic cholangiocarcinoma (n = 2). Two patients had 2-stage laparoscopic resections for bilobar colorectal carcinoma liver metastasis. Three patients had repeated liver resection for recurrent colorectal carcinoma liver metastasis. Forty-two major hepatectomies (32%) were performed. The median operative time was 210 minutes (range, 30-480 minutes). The median postoperative length of stay was 4 days (range, 1-15 days). Seven patients required conversion to formal open surgery and 4 patients required conversion to a laparoscopic-assisted procedure. Sixteen patients (13%) developed significant postoperative complications. One patient (0.8%) died in the hospital. In the 17 patients with neuroendocrine tumor metastasis, 6 (35%) had microscopic positive resection margins. Most of these patients underwent debulking and cytoreductive surgery. A microscopic negative resection margin was obtained in the remaining 112 of 116 resections (97%). We recorded 2-year overall survivals of 80%, 77%, and 91% in the groups with colorectal carcinoma liver metastasis, hepatocellular carcinoma, and neuroendocrine tumor metastasis, respectively. Our data support the safety and oncological efficiency of laparoscopic resection for liver malignant neoplasms. Adequate patient selection and extensive experience in hepatic and laparoscopic surgery are essential prerequisites to optimize outcomes.
    Archives of surgery (Chicago, Ill.: 1960) 01/2012; 147(1):42-8. DOI:10.1001/archsurg.2011.856 · 4.93 Impact Factor
Show more