Annals of Surgical Oncology

, Volume 22, Issue 1, pp 173–179 | Cite as

Impact of Margin Status and Neoadjuvant Chemotherapy on Survival, Recurrence After Liver Resection for Colorectal Liver Metastasis

  • Sanjay Pandanaboyana
  • Alan White
  • Samir Pathak
  • Ernest L. Hidalgo
  • Giles Toogood
  • J. P. Lodge
  • K. R. Prasad
Hepatobiliary Tumors

Abstract

Background

This study was designed to determine the impact of positive margin and neoadjuvant chemotherapy (NAC) on recurrence and survival after resection of colorectal liver metastasis (CRLM).

Methods

Prospective analysis of 1,255 patients undergoing resection of CLRM was undertaken. The impact of NAC, site of recurrence, and survival between R0 and R1 groups was analysed.

Results

The R0 and R1 resection rates were 68.9 % (n = 865) and 31.1 % (390). The median OS for R0 group was 2.7 years (95 % CI 2.56–2.85) and R1 group 2.28 years (CI 2.06–2.52; P < 0.001). The median DFS for R0 group was 1.52 years (CI 1.38–1.66) and R1 group 1.04 years (CI 0.94–1.19; P < 0.001). The intrahepatic recurrence was higher in R1 group 132 (33.8 %) versus 142 (16.4 %) [P = 0.0001]. A total of 103 (11.9 %) patients in R0 group underwent redo liver resection for recurrence compared with 66 (16.9 %) patients in R1 group (P = 0.016). NAC did not impact recurrence rate (57.8 % vs. 61.5 %, P = 0.187) and redo liver surgery between R0 and R1 groups (13 % vs. 17 %, P = 0.092). Within the R1 group, the intrahepatic recurrence rates were similar with and without NAC (33.9 % vs. 33.7 %, P = 0.669). However, DFS was longer in the no chemotherapy group than the chemotherapy group.

Conclusions

R1 resections increase the likelihood of recurrence in the liver and redo liver surgery. NAC does not seem to improve survival in margin positive patients or have an impact on recurrence or reduce need for redo liver surgery for recurrence. In patients with R1 resection, neoadjuvant chemotherapy may have adverse outcome on disease free survival.

Keywords

Liver Resection Colorectal Liver Metastasis Margin Status Future Liver Remnant Chemotherapy Group 

Notes

Disclosure

None.

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Copyright information

© Society of Surgical Oncology 2014

Authors and Affiliations

  • Sanjay Pandanaboyana
    • 1
  • Alan White
    • 1
  • Samir Pathak
    • 1
  • Ernest L. Hidalgo
    • 1
  • Giles Toogood
    • 1
  • J. P. Lodge
    • 1
  • K. R. Prasad
    • 1
  1. 1.Department of HPB and Transplant SurgerySt James’s University Hospital NHS TrustWest YorkshireUK

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