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One-millimeter cancer-free margin is curative for colorectal liver metastases: a propensity score case-match approach

One-millimeter cancer-free margin is curative for colorectal liver metastases: a propensity score case-match approach
One-millimeter cancer-free margin is curative for colorectal liver metastases: a propensity score case-match approach

OBJECTIVE: To investigate the influence of clear surgical resection margin width on disease recurrence rate after intentionally curative resection of colorectal liver metastases.

BACKGROUND: There is consensus that a histological positive resection margin is a predictor of disease recurrence after resection of colorectal liver metastases. The dispute, however, over the width of cancer-free resection margin required is ongoing.

METHODS: Analysis of observational prospectively collected data for 2715 patients who underwent primary resection of colorectal liver metastases from 2 major hepatobiliary units in the United Kingdom. Histological cancer-free resection margin was classified as positive (if cancer cells present at less than 1 mm from the resection margin) or negative (if the distance between the cancer and the margin is 1 mm or more). The negative margin was further classified according to the distance from the tumor in millimeters. Predictors of disease-free survival were analyzed in univariate and multivariate analyses. A case-match analysis by a propensity score method was undertaken to reduce bias.

RESULTS: A 1-mm cancer-free resection margin was sufficient to achieve 33% 5-year overall disease-free survival. Extra margin width did not add disease-free survival advantage (P > 0.05). After the propensity case-match analysis, there is no statistical difference in disease-free survival between patients with negative narrow and wider margin clearance [hazard ratio (HR) 1.0; 95% (confidence interval) CI: 0.9-1.2; P = 0.579 at 5-mm cutoff and HR 1.1; 95% CI: 0.96-1.3; P = 0.149 at 10-mm cutoff]. Patients with extrahepatic disease and positive lymph node primary tumor did not have disease-free survival advantage despite surgical margin clearance (9 months for <1-mm vs 12 months for ≥1-mm margin clearance; P = 0.062).

CONCLUSION: One-mm cancer-free resection margin achieved in patients with colorectal liver metastases should now be considered the standard of care.

Adult, Aged, Aged, 80 and over, Colorectal Neoplasms/pathology, Disease-Free Survival, Female, Follow-Up Studies, Hepatectomy/methods, Humans, Liver Neoplasms/diagnosis, Male, Middle Aged, Neoplasm Recurrence, Local/mortality, Prognosis, Propensity Score, Retrospective Studies, Risk Factors, Survival Rate/trends, Treatment Outcome, United Kingdom/epidemiology, Young Adult
0003-4932
543-8
Hamady, Zaed Z R
545a1c81-276e-4341-a420-aa10aa5d8ca8
Lodge, J Peter A
c97dd104-0cb2-4f05-a008-9b9af01e4820
Welsh, Fenella K
f3546a2f-1f43-4fe9-8239-e2ad1083c0fa
Toogood, Giles J
f2183798-4d71-42fd-bcc9-483f191c066f
White, Alan
3ca06e6c-dc9f-40f9-93c0-694fbeab5e6c
John, Timothy
78e0c300-b275-4fbd-ad7a-9fe78f7f6734
Rees, Myrddin
f35b89e2-e207-439f-b685-7b6dcbaea214
Hamady, Zaed Z R
545a1c81-276e-4341-a420-aa10aa5d8ca8
Lodge, J Peter A
c97dd104-0cb2-4f05-a008-9b9af01e4820
Welsh, Fenella K
f3546a2f-1f43-4fe9-8239-e2ad1083c0fa
Toogood, Giles J
f2183798-4d71-42fd-bcc9-483f191c066f
White, Alan
3ca06e6c-dc9f-40f9-93c0-694fbeab5e6c
John, Timothy
78e0c300-b275-4fbd-ad7a-9fe78f7f6734
Rees, Myrddin
f35b89e2-e207-439f-b685-7b6dcbaea214

Hamady, Zaed Z R, Lodge, J Peter A, Welsh, Fenella K, Toogood, Giles J, White, Alan, John, Timothy and Rees, Myrddin (2014) One-millimeter cancer-free margin is curative for colorectal liver metastases: a propensity score case-match approach. Annals of Surgery, 259 (3), 543-8. (doi:10.1097/SLA.0b013e3182902b6e).

Record type: Article

Abstract

OBJECTIVE: To investigate the influence of clear surgical resection margin width on disease recurrence rate after intentionally curative resection of colorectal liver metastases.

BACKGROUND: There is consensus that a histological positive resection margin is a predictor of disease recurrence after resection of colorectal liver metastases. The dispute, however, over the width of cancer-free resection margin required is ongoing.

METHODS: Analysis of observational prospectively collected data for 2715 patients who underwent primary resection of colorectal liver metastases from 2 major hepatobiliary units in the United Kingdom. Histological cancer-free resection margin was classified as positive (if cancer cells present at less than 1 mm from the resection margin) or negative (if the distance between the cancer and the margin is 1 mm or more). The negative margin was further classified according to the distance from the tumor in millimeters. Predictors of disease-free survival were analyzed in univariate and multivariate analyses. A case-match analysis by a propensity score method was undertaken to reduce bias.

RESULTS: A 1-mm cancer-free resection margin was sufficient to achieve 33% 5-year overall disease-free survival. Extra margin width did not add disease-free survival advantage (P > 0.05). After the propensity case-match analysis, there is no statistical difference in disease-free survival between patients with negative narrow and wider margin clearance [hazard ratio (HR) 1.0; 95% (confidence interval) CI: 0.9-1.2; P = 0.579 at 5-mm cutoff and HR 1.1; 95% CI: 0.96-1.3; P = 0.149 at 10-mm cutoff]. Patients with extrahepatic disease and positive lymph node primary tumor did not have disease-free survival advantage despite surgical margin clearance (9 months for <1-mm vs 12 months for ≥1-mm margin clearance; P = 0.062).

CONCLUSION: One-mm cancer-free resection margin achieved in patients with colorectal liver metastases should now be considered the standard of care.

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More information

Published date: March 2014
Keywords: Adult, Aged, Aged, 80 and over, Colorectal Neoplasms/pathology, Disease-Free Survival, Female, Follow-Up Studies, Hepatectomy/methods, Humans, Liver Neoplasms/diagnosis, Male, Middle Aged, Neoplasm Recurrence, Local/mortality, Prognosis, Propensity Score, Retrospective Studies, Risk Factors, Survival Rate/trends, Treatment Outcome, United Kingdom/epidemiology, Young Adult

Identifiers

Local EPrints ID: 455112
URI: http://eprints.soton.ac.uk/id/eprint/455112
ISSN: 0003-4932
PURE UUID: 3f1c051f-a513-421e-9469-0d3053dc6aa7
ORCID for Zaed Z R Hamady: ORCID iD orcid.org/0000-0002-4591-5226

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Date deposited: 10 Mar 2022 17:30
Last modified: 17 Mar 2024 04:12

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Contributors

Author: Zaed Z R Hamady ORCID iD
Author: J Peter A Lodge
Author: Fenella K Welsh
Author: Giles J Toogood
Author: Alan White
Author: Timothy John
Author: Myrddin Rees

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