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What Is the Impact of Positive Margins in the Liver?

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Colorectal Cancer Liver Metastases

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Abstract

In this chapter, we will discuss what is the impact of positive margin and the optimal width after hepatectomy for CRLM. Several clinicopathological factors have been found to be independent predictors of survival. Resection margin status and width have been historically an important prognostic factor. Yet, more recent studies have challenged the oncologic impact of close or microscopically positive (R1) resection. This is particularly important to understand, as this is one factor which is potentially under the control of the surgeon.

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References

  1. Siegel RL, Ward EM, Jemal A. Trends in colorectal cancer incidence rates in the United States by tumor location and stage, 1992–2008. Cancer Epidemiol Biomark Prev. 2012;21:411–6. https://doi.org/10.1158/1055-9965.EPI-11-1020.

    Article  Google Scholar 

  2. Nassour I, Polanco PM. Minimally invasive liver surgery for hepatic colorectal metastases. Curr Colorectal Cancer Rep. 2016;12:1–10. https://doi.org/10.1007/s11888-016-0316-7.

    Article  Google Scholar 

  3. Scheele J, Stangl R, Altendorf-Hofmann A, Gall FP. Indicators of prognosis after hepatic resection for colorectal secondaries. Surgery. 1991;110:13–29.

    PubMed  CAS  Google Scholar 

  4. Hughes KS, Rosenstein RB, Songhorabodi S, et al. Resection of the liver for colorectal carcinoma metastases. A multi-institutional study of long-term survivors. Dis Colon Rectum. 1988;31:1–4. https://doi.org/10.1007/BF02552560.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  5. Fong Y, Fortner J, Sun RL, et al. Clinical score for predicting recurrence after hepatic resection for metastatic colorectal cancer: analysis of 1001 consecutive cases. Ann Surg. 1999;230:309–18. – discussion 318–21.

    Article  CAS  Google Scholar 

  6. Wang J, Margonis GA, Amini N, et al. The prognostic value of varying definitions of positive resection margin in patients with colorectal cancer liver metastases. J Gastrointest Surg. 2018;22:1350–7. https://doi.org/10.1007/s11605-018-3748-3.

    Article  PubMed  Google Scholar 

  7. de Haas RJ, Wicherts DA, Flores E, et al. R1 resection by necessity for colorectal liver metastases: is it still a contraindication to surgery? Ann Surg. 2008;248(4):626–37. https://doi.org/10.1097/SLA.0b013e31818a07f1.

    Article  PubMed  Google Scholar 

  8. Pawlik TM, Scoggins CR, Zorzi D, et al. Effect of surgical margin status on survival and site of recurrence after hepatic resection for colorectal metastases. Ann Surg. 2005;241:715–22– discussion 722–4. https://doi.org/10.1097/01.sla.0000160703.75808.7d.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Liu W, Sun Y, Zhang L, Xing B-C. Negative surgical margin improved long-term survival of colorectal cancer liver metastases after hepatic resection: a systematic review and meta-analysis. Int J Color Dis. 2015;30:1365–73. https://doi.org/10.1007/s00384-015-2323-6.

    Article  Google Scholar 

  10. Van Dam RM, Lodewick TM, van den Broek MAJ, et al. Outcomes of extended versus limited indications for patients undergoing a liver resection for colorectal cancer liver metastases. HPB (Oxford). 2014;16:550–9. https://doi.org/10.1111/hpb.12181.

    Article  Google Scholar 

  11. Viganò L, Capussotti L, Majno P, et al. Liver resection in patients with eight or more colorectal liver metastases. Br J Surg. 2015;102:92–101. https://doi.org/10.1002/bjs.9680.

    Article  PubMed  Google Scholar 

  12. Andreou A, Aloia TA, Brouquet A, et al. Margin status remains an important determinant of survival after surgical resection of colorectal liver metastases in the era of modern chemotherapy. Ann Surg. 2013;257:1079–88. https://doi.org/10.1097/SLA.0b013e318283a4d1.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Sadot E, Groot Koerkamp B, Leal JN, et al. Resection margin and survival in 2368 patients undergoing hepatic resection for metastatic colorectal cancer: surgical technique or biologic surrogate? Ann Surg. 2015;262:476–85– discussion 483–5. https://doi.org/10.1097/SLA.0000000000001427.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Viganò L, Procopio F, Cimino MM, et al. Is tumor detachment from vascular structures equivalent to R0 resection in surgery for colorectal liver metastases? An observational cohort. Ann Surg Oncol. 2016;23:1352–60. https://doi.org/10.1245/s10434-015-5009-y.

    Article  PubMed  Google Scholar 

  15. Eveno C, Karoui M, Gayat E, et al. Liver resection for colorectal liver metastases with peri-operative chemotherapy: oncological results of R1 resections. HPB (Oxford). 2013;15:359–64. https://doi.org/10.1111/j.1477-2574.2012.00581.x.

    Article  Google Scholar 

  16. Kornprat P, Jarnagin WR, Gonen M, et al. Outcome after hepatectomy for multiple (four or more) colorectal metastases in the era of effective chemotherapy. Ann Surg Oncol. 2007;14:1151–60. https://doi.org/10.1245/s10434-006-9068-y.

    Article  PubMed  Google Scholar 

  17. Malik HZ, Hamady ZZR, Adair R, et al. Prognostic influence of multiple hepatic metastases from colorectal cancer. Eur J Surg Oncol. 2007;33:468–73. https://doi.org/10.1016/j.ejso.2006.09.030.

    Article  PubMed  CAS  Google Scholar 

  18. Tanaka K, Shimada H, Ueda M, et al. Role of hepatectomy in treating multiple bilobar colorectal cancer metastases. Surgery. 2008;143:259–70. https://doi.org/10.1016/j.surg.2007.08.015.

    Article  PubMed  Google Scholar 

  19. Adam R, Delvart V, Pascal G, et al. Rescue surgery for unresectable colorectal liver metastases downstaged by chemotherapy: a model to predict long-term survival. Ann Surg. 2004;240(4):644–58.

    PubMed  PubMed Central  Google Scholar 

  20. Yamashita S, Hasegawa K, Takahashi M, et al. One-stage hepatectomy following portal vein embolization for colorectal liver metastasis. World J Surg. 2013;37:622–8. https://doi.org/10.1007/s00268-012-1861-0.

    Article  PubMed  Google Scholar 

  21. Margonis GA, Spolverato G, Kim Y, et al. Intraoperative surgical margin re-resection for colorectal liver metastasis: is it worth the effort? J Gastrointest Surg. 2015;19:699–707. https://doi.org/10.1007/s11605-014-2710-2.

    Article  PubMed  Google Scholar 

  22. Margonis GA, Sergentanis TN, Ntanasis-Stathopoulos I, et al. Impact of surgical margin width on recurrence and overall survival following R0 hepatic resection of colorectal metastases: a systematic review and meta-analysis. Ann Surg. 2018;267:1047–55. https://doi.org/10.1097/SLA.0000000000002552.

    Article  PubMed  Google Scholar 

  23. Are C, Gonen M, Zazzali K, et al. The impact of margins on outcome after hepatic resection for colorectal metastasis. Ann Surg. 2007;246:295–300. https://doi.org/10.1097/SLA.0b013e31811ea962.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Hamady ZZR, Lodge JPA, Welsh FK, et al. One-millimeter cancer-free margin is curative for colorectal liver metastases: a propensity score case-match approach. Ann Surg. 2014;259:543–8. https://doi.org/10.1097/SLA.0b013e3182902b6e.

    Article  PubMed  Google Scholar 

  25. Viganò L, Costa G, Cimino MM, et al. R1 resection for colorectal liver metastases: a survey questioning surgeons about its incidence, clinical impact, and management. J Gastrointest Surg. 2018;22:1752–63. https://doi.org/10.1007/s11605-018-3820-z.

    Article  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Surgery, UT Southwestern Medical Center, Dallas, TX, USA

    Ibrahim Nassour

  2. Banner MD Anderson Cancer Center, Phoenix, AZ, USA

    Michael A. Choti

Authors
  1. Ibrahim Nassour
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  2. Michael A. Choti
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Correspondence to Michael A. Choti .

Editor information

Editors and Affiliations

  1. National Cancer Institute, Rio de Janeiro, Brazil

    Mauro Monteiro Correia

  2. Banner MD Anderson Cancer Center, Phoenix, AZ, USA

    Michael A. Choti

  3. Virginia Mason Medical Center, Seattle, WA, USA

    Flavio G. Rocha

  4. Center for Advanced Treatment of HBP Diseases, Ageo Central General Hospital, Ageo Shi, Saitama, Japan

    Go Wakabayashi

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Nassour, I., Choti, M.A. (2020). What Is the Impact of Positive Margins in the Liver?. In: Correia, M., Choti, M., Rocha, F., Wakabayashi, G. (eds) Colorectal Cancer Liver Metastases. Springer, Cham. https://doi.org/10.1007/978-3-030-25486-5_9

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  • DOI: https://doi.org/10.1007/978-3-030-25486-5_9

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-25485-8

  • Online ISBN: 978-3-030-25486-5

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