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Effect of SurgicalMargin Status onSurvival and Site ofRecurrence AfterHepatic Resection forColorectal Metastases Timothy M. PawlikCharles R. ScogginsDaria Zorzi2005 год

Effect of Surgical Margin Status on Survival and Site of Recurrence After Hepatic Resection for Colorectal Metastases
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Аннотация: In Brief Objective: To evaluate the influence of surgical margin status on survival and site of recurrence in patients treated with hepatic resection for colorectal metastases. Methods: 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. Results: 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 ≥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 ≥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 ≥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. Conclusions: 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. The effect of surgical margin status on survival and pattern of recurrence in 557 patients who underwent hepatic resection of colorectal metastasis was analyzed. We report that a positive margin 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.
Год издания: 2005
Авторы: Timothy M. Pawlik, Charles R. Scoggins, Daria Zorzi, Eddie K. Abdalla, Axel Andrès, Cathy Eng, Steven A. Curley, Evelyne M. Loyer, Andrea Muratore, Gilles Mentha, Lorenzo Capussotti, Jean‐Nicolas Vauthey
Издательство: Lippincott Williams & Wilkins
Источник: Annals of Surgery
Ключевые слова: Hepatocellular Carcinoma Treatment and Prognosis, Cholangiocarcinoma and Gallbladder Cancer Studies, Colorectal Cancer Treatments and Studies
Другие ссылки: Annals of Surgery (HTML)
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archive-ouverte.unige.ch (HTML)
PubMed Central (HTML)
PubMed (HTML)