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Margin Status Remains an Important Determinant of Survival After Surgical Resection of Colorectal Liver Metastases in the Era of Modern Chemotherapy

Andreou, Andreas MD*; Aloia, Thomas A. MD, FACS*; Brouquet, Antoine MD*; Dickson, Paxton V. MD*; Zimmitti, Giuseppe MD*; Maru, Dipen M. MD; Kopetz, Scott MD, PhD; Loyer, Evelyne M. MD§; Curley, Steven A. MD, FACS*; Abdalla, Eddie K. MD, FACS*; Vauthey, Jean-Nicolas MD, FACS*

Annals of Surgery:
doi: 10.1097/SLA.0b013e318283a4d1
Original Articles
Abstract

Objective: To determine the impact of surgical margin status on overall survival (OS) of patients undergoing hepatectomy for colorectal liver metastases after modern preoperative chemotherapy.

Background: In the era of effective chemotherapy for colorectal liver metastases, the association between surgical margin status and survival has become controversial.

Methods: Clinicopathologic data and outcomes for 378 patients treated with modern preoperative chemotherapy and hepatectomy were analyzed. The effect of positive margins on OS was analyzed in relation to pathologic and computed tomography–based morphologic response to chemotherapy.

Results: Fifty-two of 378 resections (14%) were R1 resections (tumor-free margin <1 mm). The 5-year OS rates for patients with R0 resection (margin ≥1 mm) and R1 resection were 55% and 26%, respectively (P = 0.017). Multivariate analysis identified R1 resection (P = 0.03) and a minor pathologic response to chemotherapy (P = 0.002) as the 2 factors independently associated with worse survival. The survival benefit associated with negative margins (R0 vs R1 resection) was greater in patients with suboptimal morphologic response (5-year OS rate: 62% vs 11%; P = 0.007) than in patients with optimal response (3-year OS rate: 92% vs 88%; P = 0.917) and greater in patients with a minor pathologic response (5-year OS rate: 46% vs 0%; P = 0.002) than in patients with a major response (5-year OS rate: 63% vs 67%; P = 0.587).

Conclusions: In the era of modern chemotherapy, negative margins remain an important determinant of survival and should be the primary goal of surgical therapy. The impact of positive margins is most pronounced in patients with suboptimal response to systemic therapy.

In Brief

In this era of effective chemotherapy for colorectal liver metastases, the association between surgical margin status after resection of colorectal liver metastases and survival has become controversial. We show here that a negative margin remains an important determinant of survival and should be the primary goal of surgical therapy in patients undergoing resection of colorectal liver metastases. The impact of positive margins is most pronounced in patients with a suboptimal response to systemic therapy.

Author Information

Departments of *Surgical Oncology

Pathology

Gastrointestinal Medical Oncology

§Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX.

Reprints: Jean-Nicolas Vauthey, MD, FACS, Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1484, Houston, TX 77030. E-mail: jvauthey@mdanderson.org.

Presented at the 97th Annual Clinical Congress of the American College of Surgeon, San Francisco, CA, October 23–27, 2011.

Disclosure: Supported in part by the National Institutes of Health through MD Anderson's Cancer Center Support grant CA016672. The authors report no conflicts of interest relevant to this article.

© 2013 Lippincott Williams & Wilkins, Inc.