Resection margin and recurrence-free survival after liver resection of colorectal metastases

Andrea Muratore, Dario Ribero, Giuseppe Zimmitti, Alfredo Mellano, Serena Langella, Lorenzo Capussotti

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Abstract

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.

Original languageEnglish
Pages (from-to)1324-1329
Number of pages6
JournalAnnals of Surgical Oncology
Volume17
Issue number5
DOIs
Publication statusPublished - May 2010

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Neoplasm Metastasis
Recurrence
Survival
Liver
Margins of Excision
Hepatectomy
Neoplasms
Databases
Drug Therapy
Lung

ASJC Scopus subject areas

  • Oncology
  • Surgery

Cite this

Resection margin and recurrence-free survival after liver resection of colorectal metastases. / Muratore, Andrea; Ribero, Dario; Zimmitti, Giuseppe; Mellano, Alfredo; Langella, Serena; Capussotti, Lorenzo.

In: Annals of Surgical Oncology, Vol. 17, No. 5, 05.2010, p. 1324-1329.

Research output: Contribution to journalArticle

Muratore, Andrea ; Ribero, Dario ; Zimmitti, Giuseppe ; Mellano, Alfredo ; Langella, Serena ; Capussotti, Lorenzo. / Resection margin and recurrence-free survival after liver resection of colorectal metastases. In: Annals of Surgical Oncology. 2010 ; Vol. 17, No. 5. pp. 1324-1329.
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abstract = "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.",
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T1 - Resection margin and recurrence-free survival after liver resection of colorectal metastases

AU - Muratore, Andrea

AU - Ribero, Dario

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AU - Mellano, Alfredo

AU - Langella, Serena

AU - Capussotti, Lorenzo

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N2 - 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.

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