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The Prognostic Value of Varying Definitions of Positive Resection Margin in Patients with Colorectal Cancer Liver Metastases

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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

Varying definitions of resection margin clearance are currently employed among patients with colorectal cancer liver metastases (CRLM). Specifically, a microscopically positive margin (R1) has alternatively been equated with an involved margin (margin width = 0 mm) or a margin width < 1 mm. Consequently, patients with a margin width of 0–1 mm (sub-mm) are inconsistently classified in either the R0 or R1 categories, thus obscuring the prognostic implications of sub-mm margins.

Methods

Six hundred thirty-three patients who underwent resection of CRLM were identified. Both R1 definitions were alternatively employed and multivariable analysis was used to determine the predictive power of each definition, as well as the prognostic implications of a sub-mm margin.

Results

Five hundred thirty-nine (85.2%) patients had a margin width ≥ 1 mm, 42 had a sub-mm margin width, and 52 had an involved margin (0 mm). A margin width ≥ 1 mm was associated with improved survival vs. a sub-mm margin (65 vs. 36 months; P = 0.03) or an involved margin (65 vs. 33 months; P < 0.001). No significant difference in survival was detected between patients with involved vs. sub-mm margins (P = 0.31). A sub-mm margin and an involved margin were both independent predictors of worse OS (HR 1.66, 1.04–2.67; P = 0.04, and HR 2.14, 1.46–3.16; P < 0.001, respectively) in multivariable analysis. Importantly, after combining the two definitions, patients with either an involved margin or a sub-mm margin were associated with worse OS in multivariable analysis (HR 1.94, 1.41–2.65; P < 0.001).

Conclusions

Patients with involved or sub-mm margins demonstrated a similar inferior OS vs. patients with a margin width > 1 mm. Consequently, a uniform definition of R1 as a margin width < 1 mm should perhaps be employed by future studies.

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Acknowledgments

Georgios Antonios Margonis was supported by the Bodossaki Foundation.

Author information

Author notes

  1. Jane Wang and Georgios Antonios Margonis contributed equally to this work.

Authors and Affiliations

  1. Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Jane Wang, Georgios Antonios Margonis, Neda Amini, Nikolaos Andreatos, Chunhui Yuan, Stefan Buettner, Carlotta Barbon, Amar Deshwar, Jin He, Richard Burkhart, Timothy M. Pawlik, Christopher L. Wolfgang & Matthew J. Weiss

  2. Second Department of Propedeutic Surgery, “Laiko” General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece

    Christos Damaskos, Efstathios Antoniou & Nikolaos Garmpis

  3. Pancreas Cancer Multidisciplinary Clinic, Liver Cancer Multidisciplinary Clinic, Surgical Oncology Fellowship, Johns Hopkins University, 600 N. Wolfe Street, Halsted 608, Baltimore, MD, 21287, USA

    Matthew J. Weiss

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  1. Jane Wang
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Contributions

All researchers were ultimately involved and each named author has made a significant contribution.

Specifically:

Jane Wang: conception and design, analysis and interpretation of data, drafting and critically revising the article, final approval of the version to be published, agreement to be accountable for all aspects of the work

Georgios Antonios Margonis: conception and design, analysis and interpretation of data, drafting and critically revising the article, final approval of the version to be published, agreement to be accountable for all aspects of the work

Neda Amini: conception and design, analysis and interpretation of data, critically revising the article, final approval of the version to be published, agreement to be accountable for all aspects of the work

Nikolaos Andreatos: interpretation of data, critically revising the article, final approval of the version to be published, agreement to be accountable for all aspects of the work

Chunhui Yuan: interpretation of data, critically revising the article, final approval of the version to be published, agreement to be accountable for all aspects of the work

Christos Damaskos: design, critically revising the article, final approval of the version to be published, agreement to be accountable for all aspects of the work

Efstathios Antoniou: design, critically revising the article, final approval of the version to be published, agreement to be accountable for all aspects of the work

Nikolaos Garmpis: design, critically revising the article, final approval of the version to be published, agreement to be accountable for all aspects of the work

Stefan Buettner: design, critically revising the article, final approval of the version to be published, agreement to be accountable for all aspects of the work

Carlotta Barbon: design, critically revising the article, final approval of the version to be published, agreement to be accountable for all aspects of the work

Amar Deshwar: interpretation of data, critically revising the article, final approval of the version to be published, agreement to be accountable for all aspects of the work

Jin He: interpretation of data, critically revising the article, final approval of the version to be published, agreement to be accountable for all aspects of the work

Richard Burkhart: interpretation of data, critically revising the article, final approval of the version to be published, agreement to be accountable for all aspects of the work

Timothy M. Pawlik: interpretation of data, critically revising the article, final approval of the version to be published, agreement to be accountable for all aspects of the work

Christopher L. Wolfgang: conception and design, interpretation of data, critically revising the article, final approval of the version to be published, agreement to be accountable for all aspects of the work

Matthew J. Weiss: conception and design, interpretation of data, critically revising the article, final approval of the version to be published, agreement to be accountable for all aspects of the work

Corresponding author

Correspondence to Matthew J. Weiss.

Ethics declarations

The study was approved by the Institutional Review Board of the Johns Hopkins Medical Institute.

Conflict of Interest

The authors declare that they have no competing interests.

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Wang, J., Margonis, G.A., Amini, N. et al. The Prognostic Value of Varying Definitions of Positive Resection Margin in Patients with Colorectal Cancer Liver Metastases. J Gastrointest Surg 22, 1350–1357 (2018). https://doi.org/10.1007/s11605-018-3748-3

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  • DOI: https://doi.org/10.1007/s11605-018-3748-3

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