Influence of surgical margin on type of recurrence after liver resection for colorectal metastases: a single-center experience

Nuzzo, Gennaro; Giuliante, Felice; Ardito, Francesco; Vellone, Maria; Giovannini, Ivo; Federico, Bruno; Vecchio, Fabio Maria

doi:10.1016/j.surg.2007.09.038

Cited by 114 publications

(106 citation statements)

References 32 publications

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“…In our study mortality rate was zero despite the limited number of patients, and major complications occurred in one patient only. Although numerous studies report a transfusion rate of packed red blood cells below 10% [9,10] or 30% [7,24], in our study 45% of the patients were transfused with packed red blood cells. However, all transfusions were carried out intraoperatively, but study criteria were followed only in one case.…”

Section: Discussioncontrasting

confidence: 57%

Ultrasound-guided liver resection: Early experience in a district general hospital

Grondona

Meola

Floris

et al. 2008

Journal of Ultrasound

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KEYWORDSIntraoperative ultrasonography; Liver resection; Hepatocellular carcinoma; Liver metastases.Abstract Introduction: Intraoperative ultrasonography (IOUS) is the gold standard for tumor staging and operative decision making in liver surgery. Providing dynamic information on tumorevessel relationships and distribution of intrahepatic veins, IOUS is also an important support for guiding the resection. Few authors report an extensive use of IOUS-guidance as a safe and effective approach. The aim of this study is to investigate the short-term results of an early experience of ultrasound (US) guided liver resection. Methods: From December 2005 to December 2007 an extensive use of IOUS-guided resection was applied in 11 consecutive patients (8 males and 3 females; median age 74 years). Perioperative data were collected prospectively to assess the influence of this approach on mortality, morbidity and early recurrence. Results: Four patients had hepatocellular carcinoma, 4 liver metastases, 1 peripheral cholangiocarcinoma, 1 hemangioma and 1 inflammatory pseudotumor. A median of 1 (range: 1e4) nodule per patient was resected. Median lesion size was 44 mm. Liver procedures included: 3 wedge resections, 3 subsegmentectomies, 4 segmentectomies and 3 bisegmentectomies. Median blood loss was 235 ml. Median surgical margin in cancer patients was 5 mm (range: 1e12). An average of 1 unit of blood transfusion was administered in 5 patients. Median postoperative hospital stay was 9 days. There was no mortality. Major complications occurred in 1 patient and minor complications in 5 patients. During a median follow-up of 14 months no recurrences were observed. Conclusions: In this study, use of IOUS-guided liver resection performed in a district general hospital proved to be a safe and effective approach in terms of short-term outcome.Sommario Premessa: Nell'ambito della chirurgia epatica l'ecografia intraoperatoria svolge un ruolo ben codificato nella stadiazione e nella pianificazione della strategia operatoria. L'importanza dell'ampio utilizzo di questa metodica anche durante la resezione è stata riportata solo da alcuni autori. Questo studio ha come scopo di verificare quali siano i risultati a breve termine di un ampio utilizzo dell'ecografia durante la resezione stessa in un ospedale periferico. Metodi: Nell'arco di 24 mesi 11 pazienti consecutivi sono stati sottoposti a resezione epatica ecoguidata. I dati perioperatori sono stati raccolti in modo prospettico per valutare l'influenza di questa metodica sulla mortalità, morbidità e recidive locali. * Corresponding author. via Peschiera 40/7, 16122 Genova, Italia.E-mail address: pietrogrondona@yahoo.com (P. Grondona). Risultati: Otto pazienti erano maschi. Età mediana 74 anni. Quattro HCC, 4 metastasi, 1 colangiocarcinoma periferico, 1 emangioma, 1 pseudotumore infiammatorio. Sono state eseguite 3 resezioni a cuneo, 3 subsegmentectomie, 4 segmentectomie e 3 bisegmentectomie. La perdita ematica mediana è stata 235 ml. In caso di tumore il margine di exeresi mediano è st...

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Section: Discussioncontrasting

confidence: 57%

Ultrasound-guided liver resection: Early experience in a district general hospital

Grondona

Meola

Floris

et al. 2008

Journal of Ultrasound

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“…Regardless of the technique used, negative margin resection remains critical. There is no role for a marginpositive operation, and multiple studies have shown higher local recurrence rates and diminished survival when hepatic resection margins are positive [41,[44][45][46][47][48][49][50].…”

Section: Surgical Techniquesmentioning

confidence: 99%

Designing Liver Resections and Pushing the Envelope with Resections for Hepatic Colorectal Metastases

Guye

Schoellhammer

Chiu

et al. 2013

Indian J Surg Oncol

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Current concepts in the management of hepatic metastases have changed dramatically over the past two decades. Multidisciplinary therapies including chemotherapy, surgery, and regional therapy have alone and in combination significantly improved the survival of patients with metastatic colorectal cancer. Conditions that were previously considered hopeless and treated merely for palliation can now be approached with curative intent. In this paper, we review the surgical treatment for colorectal cancer liver metastasis (CRLM) and describe a paradigm-shift in the management of complex heretofore-considered unresectable CRLM. Utilizing advanced multidisciplinary treatment strategies has improved the prognosis of patients with stage IV colorectal cancer to the point where we may question whether CRLM are now a chronic disease.

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“…Patients with positive margins were excluded from the current meta-analysis and only patients with negative margins were included. Many studies sub-stratified sub-centimeter negative margins into different sub-categories [4,8,10]. 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.…”

Section: Data Extraction and Definitionsmentioning

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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Influence of surgical margin on type of recurrence after liver resection for colorectal metastases: a single-center experience

Cited by 114 publications

References 32 publications

Ultrasound-guided liver resection: Early experience in a district general hospital

Ultrasound-guided liver resection: Early experience in a district general hospital

Designing Liver Resections and Pushing the Envelope with Resections for Hepatic Colorectal Metastases

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

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