Appraisal of 1 cm Hepatectomy Margins for Intrahepatic Micrometastases in Patients with Colorectal Carcinoma Liver Metastasis

Wakai, Toshifumi; Shirai, Yoshio; Sakata, Jun; Valera, Vladimir; Korita, Pavel V.; Akazawa, Kouhei; Ajioka, Yoichi; Hatakeyama, Katsuyoshi

doi:10.1245/s10434-008-0023-y

Cited by 86 publications

(84 citation statements)

References 39 publications

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“…After the application of the absolute inclusion criteria, relative inclusion criteria and removal of duplicate publications, 11 studies [3,[5][6][7][8][9][10][11][12][13][14] were included in the meta-analysis. Table 1 summarizes the study characteristics of the final 11 studies included in the meta-analysis.…”

Section: Resultsmentioning

confidence: 99%

“…For these studies, a weighted mean was calculated using the number of patients in each sub-category and the corresponding percentage survival, to compute percentage survival for the whole <1 cm negative margin sub-group. Some studies [3,[5][6][7] categorized negative margins as "≤1 cm and >1 cm" while others [4,[8][9][10][11][12][13][14] used "<1 cm and ≥1 cm" for negative margins. For the purpose of meta-analysis ≤1 cm and <1 cm were treated as "<1 cm" and > 1 cm or ≥1 cm were treated as "≥1 cm".…”

Section: Data Extraction and Definitionsmentioning

confidence: 99%

“…4a and b). There were 7 studies [3, 6, 8-10, 12, 13] published in the last 10 years and 5 studies [3,6,10,12,13] published in the last 5 years. These analyses also revealed a better DFS in patients with ≥1 cm margin compared to <1 cm negative margin and this was found to be statistically significant (Studies in the last 10 years: Odds ratio 0.509, 95 % CI 0.329 to 0.787, p00.002, heterogeneity 56.2 %, heterogeneity p0 0.033; Studies in the last 5 years: Odds ratio 0.506, 95 % CI 0.294 to 0.872, p 00.014, heterogeneity 62.8 %, heterogeneity p00.029).…”

Section: Recent Studies Published After Year 2000mentioning

confidence: 99%

“…Hepatic resection remains a well accepted modality in the treatment of patients with colorectal liver metastases (CRLM) with 5 year overall survival (OS) ranging from 37 % to 58 % [1][2][3][4] and 5 year disease free survival (DFS) ranging from 11 % to 50 % [3,[5][6][7][8][9][10][11][12][13][14]. Recurrence of the disease after resection still remains a challenge and adversely affects the long term outcomes.…”

Section: Introductionmentioning

confidence: 99%

“…Although there is a consensus that positive margins portend a worse DFS as compared to negative margins, the extent of negative margins remains controversial. Several studies have documented a DFS advantage of ≥1 cm negative margins over <1 cm negative margins of resection [5,8,10,13]. Whereas others have concluded that the width of negative margin has no influence on DFS [3,6,7,[9][10][11]14].…”

Section: Introductionmentioning

confidence: 99%

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Influence of Margins on Disease Free Survival Following Hepatic Resection for Colorectal Metastasis: A Meta-Analysis

Dhir

Lyden

Smith

et al. 2012

Indian J Surg Oncol

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The aim of our study was to conduct a metaanalysis of reports published on hepatic resection for colorectal liver metastases (CRLM) and determine if a negative margin ≥1 cm confers a disease free survival (DFS) advantage over sub-centimeter negative margins. The 357 initially selected articles were screened to identify 90 articles of interest of which eleven were finally included in the metaanalysis. Patients with positive margins were excluded from the meta-analysis. Meta-analysis was performed using STATA 9.2 statistical software. A total of 1,989 patients with negative margins from the eleven studies were included in the meta-analysis. The 5-year DFS for all patients was 27.9 % (95 % CI 23.5 % to 32.2 %). The 5-year DFS for ≥1 cm negative margin subgroup was 34.4 % (95 % CI 27.97 % to 40.7 %) when compared to 21.0 % (95 % CI 17.4 % to 24.7 %) for <1 cm negative margin subgroup. The odds ratio for ≥1 cm negative margins was found to be 0.552 (95 % CI 0.408 to 0.747, p<0.001) when compared to <1 cm negative margins. The results of this meta-analysis demonstrate that in patients undergoing hepatic resection for CRLM, a negative margin≥1 cm may confer a better DFS compared with a sub-centimeter negative margin.

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Section: Resultsmentioning

confidence: 99%

Section: Data Extraction and Definitionsmentioning

confidence: 99%

Section: Recent Studies Published After Year 2000mentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Influence of Margins on Disease Free Survival Following Hepatic Resection for Colorectal Metastasis: A Meta-Analysis

Dhir

Lyden

Smith

et al. 2012

Indian J Surg Oncol

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Clinical outcomes of neoadjuvant chemotherapy for resectable colorectal liver metastasis with intermediate risk of postoperative recurrence: A multi‐institutional retrospective study

Noda

Takahashi

Tei

et al. 2022

Annals of Gastroent Surgery

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Aims Risk‐scoring systems for colorectal liver metastasis (CRLM) after hepatectomy allow prognoses to be predicted preoperatively. We investigated the clinical outcomes of neoadjuvant chemotherapy for resectable CRLM according to patient risk status, aiming to determine the subgroup of patients who could benefit from neoadjuvant chemotherapy. Methods In this multi‐institutional retrospective analysis, the preoperative risk score was calculated from six previously reported factors: synchronous metastases, primary lymph node positivity, tumor number, largest tumor diameter, extrahepatic metastasis, and the preoperative carbohydrate antigen 19–9 level. Patients were divided into three groups according to their risk scores: low risk (score = 0), intermediate risk (score 1–10), and high risk (score ≥11). Overall and recurrence‐free survival curves were calculated using the Kaplan–Meier method. After propensity‐score matching in the intermediate‐risk group, we compared clinicopathological features and outcomes. Results There were 318 cases, from 20 institutions. The preoperative risk score could be calculated in 277 cases. There were 34, 192, and 51 patients in the low‐, intermediate‐, and high‐risk groups, respectively. Intermediate‐risk group patients who received neoadjuvant chemotherapy had significantly better recurrence‐free survival than that of patients without neoadjuvant chemotherapy ( P = .0453). After propensity‐score matching in the intermediate‐risk group, the recurrence‐free survival rate was better in patients who received neoadjuvant chemotherapy ( P = .0261). But the overall survival rate was not improved after the matching. Conclusion Neoadjuvant chemotherapy for resectable CRLM might prolong the recurrence‐free survival period for intermediate‐risk patients with preoperative risk scores in the range of 1–10, but the overall survival was not improved by neoadjuvant chemotherapy.

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Systematic review and meta-analysis of follow-up after hepatectomy for colorectal liver metastases2

Jones

Jackson

Dunne

et al. 2012

British Journal of Surgery

155

102

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Appraisal of 1 cm Hepatectomy Margins for Intrahepatic Micrometastases in Patients with Colorectal Carcinoma Liver Metastasis

Abstract: The currently recommended >/=1 cm hepatectomy margin should remain the goal for resections of colorectal carcinoma liver metastases, based on the distribution of intrahepatic micrometastases and survival risk.

Cited by 86 publications

References 39 publications

Influence of Margins on Disease Free Survival Following Hepatic Resection for Colorectal Metastasis: A Meta-Analysis

Influence of Margins on Disease Free Survival Following Hepatic Resection for Colorectal Metastasis: A Meta-Analysis

Clinical outcomes of neoadjuvant chemotherapy for resectable colorectal liver metastasis with intermediate risk of postoperative recurrence: A multi‐institutional retrospective study

Systematic review and meta-analysis of follow-up after hepatectomy for colorectal liver metastases2

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