Resection margin in patients undergoing hepatectomy for colorectal liver metastasis: A critical appraisal of the 1cm rule

Hamady, Zaed; Cameron, Iain C.; Wyatt, Judy; Prasad, Rajendra; Toogood, Giles J.; Lodge, J. Peter A.

doi:10.1016/j.ejso.2006.02.001

Cited by 135 publications

(122 citation statements)

References 22 publications

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“…We developed Cox proportional hazards regression models with allcause mortality as the dependent variable and type of chemotherapy, age at diagnosis, race, SES, marital status, year of diagnosis, stage of disease, tumour grade, type of hospital, and comorbidity score as the independent variables for all subjects who had hepatectomy. Type of liver resection was not included in the model, as it is not an independent predictor of disease recurrence or overall survival after surgical resection of metastases (Hamady et al, 2006;Zorzi et al, 2006). The Kaplan -Meier analysis was used to plot survival curves.…”

Section: Discussionmentioning

confidence: 99%

Predictors of survival after hepatic resection among patients with colorectal liver metastasis

et al. 2007

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Studies suggest improved survival following resection of colorectal cancer liver metastases (CLMs). We investigated predictors of survival among patients with CLM who underwent hepatic resection using the SEER-Medicare database to identify patients X65 years diagnosed with CLM, 1991CLM, -2003, who underwent hepatectomy. Cox proportional hazards models were used to identify factors associated with survival after hepatectomy. Of 923 patients with CLM who underwent hepatectomy, 514 were stages I -III and developed CLM46 months after diagnosis (metachronous), and 409 were stage IV with CLM at diagnosis (synchronous). From the date of hepatectomy, 5 year survival was 22%; younger age, being married, female gender, surgery in an NCI-designated cancer centre, fewer comorbidities, fewer positive lymph nodes, and lower grade were associated with improved survival. Both 5-fluorouracil (5FU)-based chemotherapy and hepatic arterial infusion (HAI) of floxuridine-based chemotherapy following hepatectomy improved survival (HR ¼ 0.62, 95% CI: 0.50 -0.78; HR ¼ 0.51, 95% CI: 0.28 -0.97, respectively) in the synchronous, but not metachronous, group. The HR for overall mortality was higher in hospitals with a high vs low procedure volume (0.75, 95% CI: 0.58 -0.94). A substantial subgroup of patients with CLM who undergo hepatectomy experiences long-term survival. High hospital procedure volume and use of 5FU-based or HAI-based chemotherapy after resection were associated with improved prognosis.

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Section: Discussionmentioning

confidence: 99%

Predictors of survival after hepatic resection among patients with colorectal liver metastasis

et al. 2007

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“…Over the last two decades, liver resection has been established as the standard therapy for CRLM and offers the best chance of a potential cure with a 5-year survival of over 40% (Finch et al, 2006;Simmonds et al, 2006). However, disease recurrence is common with about two-thirds of patients who had liver resection for CRLM developing recurrent disease, and half of these patients had the disease recur in the remnant liver (Steele et al, 1991;Nordlinger et al, 1994;Fong et al, 1997;Hamady et al, 2006). Several studies have looked for possible prognostic factors indicating poor survival outcome and disease recurrence after initial liver resection for CRLM (Fong et al, 1999;Seifert et al, 2000;Takahashi et al, 2003;Tanaka et al, 2004;Hamady et al, 2006).…”

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confidence: 99%

“…However, disease recurrence is common with about two-thirds of patients who had liver resection for CRLM developing recurrent disease, and half of these patients had the disease recur in the remnant liver (Steele et al, 1991;Nordlinger et al, 1994;Fong et al, 1997;Hamady et al, 2006). Several studies have looked for possible prognostic factors indicating poor survival outcome and disease recurrence after initial liver resection for CRLM (Fong et al, 1999;Seifert et al, 2000;Takahashi et al, 2003;Tanaka et al, 2004;Hamady et al, 2006). Primary colorectal adenocarcinoma stage and grade, size, distribution and number of liver metastases, presence of extrahepatic disease, resection margins and lymph nodes status are among the potential prognostic factors but to date, no consensus have been reached.…”

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confidence: 99%

C-reactive protein as a predictor of prognosis following curative resection for colorectal liver metastases

et al. 2007

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There is increasing evidence that systemic inflammatory response has a positive correlation with a poorer outcome in patients undergoing resection for solid tumours. The aim of this study was to analyse the impact of an elevated C-reactive protein (CRP), an outcome following curative resection for colorectal liver metastases. One hundred and seventy patients who underwent curative resection for colorectal liver metastases were included in the study. Laboratory measurements of haemoglobin, white cell, platelets, albumin and CRP were taken on the day before surgery. Elevated CRP (410 mg l À1 ) was present in 54 (31.8%) patients. The median survival of patients with an elevated CRP was 19 months (95% CI 7.5 -31.2 months) compared to 42.8 months (95% CI 33.2 -52.5 months) for those with a normal CRP, P ¼ 0.004. Similarly, when assessing disease-free survival, patients with an elevated CRP had poorer disease-free survival (median of 11.8 months (95% CI 6.4 -17.3) compared to median of 15.1 months (95% CI 11.1 -19.1)), P ¼ 0.043. The result of the study showed that an elevated preoperative CRP is a predictor of poor outcome in patients undergoing curative resection for colorectal liver metastases.

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“…These factors were studied: demographics, details of primary operation (location of the tumor, type of the procedure, interval between two operations), patient- , and follow-up and survival. All R0 resections with the absence of microscopic tumor invasions were considered as negative surgical margins without regarding the length of actual tumor-free extension [12]. Data were given as medians and ranges.…”

Section: Methodsmentioning

confidence: 99%

Stereotactic Excision of Additional Lesions Detected with Intraoperative Ultrasound Examination During Radiofrequency Dissecting Sealar (Habib®) Assisted Hepatic Metastasectomy: Report of 4 Cases

Altuntas

Unel²,

Gezen

et al. 2012

Indian J Surg

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Intraoperative ultrasound has been using to achieve a proper resection strategy in patients undergoing a hepatic colorectal metastasectomy. This study aims to describe and reveal the place of stereotactic metastasectomy in nonpalpable colorectal liver metastases (CLM). A chart review was initiated for all patients underwent resection for CLM between 2006 and 2011. The data concerning perioperative data and intraoperative strategy were abstracted. Among the 58 patients, who underwent a resection for CLM, 4 (6.9 %) (all men, median age 65.5, range 49-72, years) necessitated a stereotactic metastasectomy. Preoperative evaluations showed 1 (n01), 2 (n02), or 3 (n01) lesions, and intraoperative ultrasound (IUS) found an additional lesion in a case. Stereotactic marking was performed for nonpalpable lesions located in segments IVA, II, and VI and at the junction of segments V and VI. The margins were negative for all lesions both resected with conventional and stereotactic techniques. The examinations of the stereotactic resection materials revealed metastatic adenocarcinoma (patients n02), focal nodular hyperplasia (n 01), and abnormal benign liver histology probably induced by chemotherapy (n01). The median (range) operation and hospitalization periods were 217.5 (150-310) minutes and 5.5 (2-9) days. No complications were observed except biliary fistula in a case, which spontaneously disappeared within 2 weeks. A patient died due to systemic disease including hepatic metastases 33 months after the liver surgery. Stereotactic metastasectomy may be feasible for the removal of nonpalpable CLM. Further evaluations are necessitated to understand the accurate place of this novel technique.

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Resection margin in patients undergoing hepatectomy for colorectal liver metastasis: A critical appraisal of the 1cm rule

Cited by 135 publications

References 22 publications

Predictors of survival after hepatic resection among patients with colorectal liver metastasis

Predictors of survival after hepatic resection among patients with colorectal liver metastasis

C-reactive protein as a predictor of prognosis following curative resection for colorectal liver metastases

Stereotactic Excision of Additional Lesions Detected with Intraoperative Ultrasound Examination During Radiofrequency Dissecting Sealar (Habib®) Assisted Hepatic Metastasectomy: Report of 4 Cases

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