Tumour biology of colorectal liver metastasis is a more important factor in survival than surgical margin clearance in the era of modern chemotherapy regimens. Issue 2 (9th July 2014)

• Record Type: Journal Article
• Authors: Truant, Stéphanie; Séquier, Cédric; Leteurtre, Emmanuelle; Boleslawski, Emmanuel; Elamrani, Mehdi; Huet, Guillemette; Duhamel, Alain; Hebbar, Mohamed; Pruvot, François‐René
• Is Part Of: HPB. Volume 17:Issue 2(2015:Feb.)
• Page Start: 176
• Page End: 184
• Publication Date: 2014-07-09
• Subjects: Liver -- Diseases -- Periodicals; Biliary tract -- Diseases -- Periodicals; Pancreas -- Diseases -- Periodicals; 616.362005
• DOI: 10.1111/hpb.12316
• Languages: English
• ISSNs: 1365-182X

Abstract

<abstract abstract-type="main"> <title>Abstract</title> <sec id="hpb12316-sec-0001" sec-type="section"> <title>Background</title> <p>The aim of the authors was to reassess the impact of a positive surgical margin (R1) after a liver resection for colorectal liver metastases (CLMs) on survival in the era of modern chemotherapy, through their own experience and a literature review.</p> </sec> <sec id="hpb12316-sec-0002" sec-type="section"> <title>Methods</title> <p>Inclusion criteria were: R1 or R0 resection with no local treatment modalities, extra‐hepatic metastases or other cancer.</p> </sec> <sec id="hpb12316-sec-0003" sec-type="section"> <title>Results</title> <p>Among 337 patients operated between 2000 and 2010, 273 patients were eligible (214 R0/59 R1). The mean follow‐up was 43 ± 29 months. Compared with a R0 resection, a R1 resection offered a lower 5‐year overall (39.1% versus 54.2%, <italic>P</italic> = 0.010), disease‐free (15.2% versus 31.1%, <italic>P</italic> = 0.021) and progression‐free (i.e. time to the first non‐curable recurrence; 33.1% versus 47.3%, <italic>P</italic> = 0.033) survival rates. Metastases in the R1 group were more numerous, larger and more frequently synchronous. Independent factors of poor survival were: number, size and short‐time interval of CLM occurrence, N status, rectal primary, absence of adjuvant chemotherapy, but not a R1 resection. With the more‐systematic administration of chemotherapy since 2005, the intergroup difference in progression‐free survival disappeared (<italic>P</italic> = 0.264).</p> </sec> <sec id="hpb12316-sec-0004" sec-type="section"> <title>Conclusion</title> <p>A R1 resection had no prognostic value per se but reflected a more severe disease. The recent change in the prognostic value of a R1 resection may be linked to the beneficial effect of chemotherapy.</p> </sec> </abstract>