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Resection Margin and Survival in 2368 Patients Undergoing Hepatic Resection for Metastatic Colorectal Cancer: Surgical Technique or Biologic Surrogate?

Sadot, Eran MD*; Koerkamp, Bas Groot MD, PhD*; Leal, Julie N. MD*; Shia, Jinru MD; Gonen, Mithat PhD; Allen, Peter J. MD*; DeMatteo, Ronald P. MD*; Kingham, T. Peter MD*; Kemeny, Nancy MD§; Blumgart, Leslie H. MD*; Jarnagin, William R. MD*; D'Angelica, Michael I. MD*

doi: 10.1097/SLA.0000000000001427
Papers of the 135th ASA Annual Meeting

Objectives: The impact of margin width on overall survival (OS) in the context of other prognostic factors after resection for colorectal liver metastases is unclear. We evaluated the relationship between resection margin and OS utilizing high-resolution histologic distance measurements.

Methods: A single-institution prospectively maintained database was queried for all patients who underwent an initial complete resection of colorectal liver metastases between 1992 and 2012. R1 resection was defined as tumor cells at the resection margin (0 mm). R0 resection was further divided into 3 groups: 0.1 to 0.9 mm, 1 to 9 mm, and 10 mm or greater.

Results: A total of 4915 liver resections were performed at Memorial Sloan Kettering Cancer Center between 1992 and 2012, from which 2368 patients were included in the current study. Half of the patients presented with synchronous disease, 43% had solitary metastasis, and the median tumor size was 3.4 cm. With a median follow-up for survivors of 55 months, the median OS of the R1, 0.1 to 0.9 mm, 1 to 9 mm, and 10 mm or more groups was 32, 40, 53, and 56 months, respectively (P < 0.001). Compared with R1 resection, all margin widths, including submillimeter margins correlated with prolonged OS (P < 0.05). The association between the margin width and OS remained significant when adjusted for all other clinicopathologic prognostic factors.

Conclusions: Resection margin width is independently associated with OS. Wide margins should be attempted whenever possible. However, resection should not be precluded if narrow margins are anticipated, as submillimeter margin clearance is associated with improved survival. The prolonged OS observed with submillimeter margins is likely a microscopic surrogate for the biologic behavior of a tumor rather than the result of surgical technique.

This study evaluated the impact of margin status in 2368 patients undergoing hepatic resection for colorectal liver metastases. Prolonged survival is independently associated with margin clearance down to submillimeter width. These findings suggest that margin clearance is important and that submillimeter margin clearance is likely a microscopic surrogate for the biologic behavior of a tumor.

Departments of *Surgery

Pathology

Epidemiology and Biostatistics, and

§Medical Oncology, Memorial Sloan Kettering Cancer Center, New York, NY.

Reprints: Michael I. D'Angelica, MD, Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065. E-mail: dangelim@mskcc.org.

Presented at the 135th Annual Meeting of the American Surgical Association, April 23–25, 2015, San Diego, CA.

Disclosure: Funded in part by the National Institutes of Health/National Cancer Institute Cancer Center Support Grant P30 CA008748. All authors declare that they have no conflict of interests regarding this study.

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