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

Abstract

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.

Circulating tumor DNA for prognosis assessment and postoperative management after curative‐intent resection of colorectal liver metastases

“…The last decade has seen an increasingly aggressive approach to management of CRLM, often with the intention to cure 3 . Nevertheless, the recurrence rate after curative intent treatment for CRLM remains high, with nearly 50% recurring within 2 years 4‐6 and a 5‐year disease‐free survival of only 27.9% 7 . Most CRLM surveillance programs involve frequent computed tomographic (CT) scans 8,9 .…”

The effects of resection margin and KRAS status on outcomes after resection of colorectal liver metastases

“…Traditionally, resection margins were classified as clear where there was a negative margin of at least 10 mm, as this has been shown to confer a survival benefit. [2][3][4][5] However, recent studies reported similar survival outcomes in patients with margins of 1-9 mm, compared to 10 mm margin resections (5-year OS rates after 10 mm and <10 mm resection of 57% and 61%, respectively). [6][7][8] This was supported by the results of large international, multi-centre retrospective study, where patients were stratified into those with positive margins, and those with negative margins of either 1-4 mm, 5-9 mm, or >10 mm.…”

Prognostic factors of overall survival in patients with recurrent disease following liver resection for colorectal cancer metastases: A multicenter external validation study

“…Despite significant advances in local and systematic therapy, colorectal cancer remains one of the top leading causes of cancer‐related deaths worldwide 1–3 . Survival rates decline significantly with metastatic disease, where the most common location of spread is to the liver 1,4,5 . In the setting of oligometastatic disease, selected patients can undergo resection of the primary and metastastatic disease with curative intent, resulting in favorable 5‐year overall survival (OS) rates from 40% to 60% 4,6,7 .…”

“…Survival rates decline significantly with metastatic disease, where the most common location of spread is to the liver 1,4,5 . In the setting of oligometastatic disease, selected patients can undergo resection of the primary and metastastatic disease with curative intent, resulting in favorable 5‐year overall survival (OS) rates from 40% to 60% 4,6,7 . However, for the significant proportion of patients who experience subsequent recurrence (i.e., following their initial liver resection), there lacks robust evidence to guide management.…”

“…There is a large repository of data evaluating prognostic factors of recurrence and death in patients who undergo liver resection for colorectal cancer liver metastases 1–7 . However, few studies have evaluated the same questions in patients who experience recurrence following liver resection despite recurrence rates of up to 60%–70% 8,9 .…”