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The Prognostic Impact of Determining Resection Margin Status for Multiple Colorectal Metastases According to the Margin of the Largest Lesion

  • Hepatobiliary Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Although the prognostic role of surgical margin status after resection of colorectal liver metastasis (CRLM) has been previously examined, controversy still surrounds the importance of surgical margin status in patients with multiple tumors.

Methods

Patients who underwent curative-intent surgery for CRLM from 2000 to 2015 and who presented with multiple tumors were identified. Patients with R1 resection status determined by the closest resection margin of the non-largest tumor were classified as R1-Type 1; patients with R1 status determined by the resection margin of the largest tumor were defined as R1-Type 2. Data regarding surgical margin status, size of tumors, and overall survival (OS) were collected and assessed.

Results

A total of 251 patients met inclusion criteria; 156 patients (62.2%) had a negative margin (R0), 50 had an R1-type 1 (19.9%), and 45 had an R1-type 2 (17.9%) margin. Median and 5-year OS in the entire cohort was 56.4 months and 48.0%, respectively. When all R1 (Type 1 + Type 2) patients were compared with R0 patients, an R1 was not associated with worse prognosis (P = 0.05). In contrast, when R1-type 2 patients were compared with R0 patients, an R1 was strongly associated with worse OS (P = 0.009). On multivariate analysis, although the prognostic impact of all R1 was not associated with OS (hazard ratio [HR] 1.56; P = 0.08), R1-Type 2 margin status independently predicted a poor outcome (HR 1.93; P = 0.03).

Conclusions

The impact of margin status varied according to the size of the tumor assessed. While R1 margin status defined according to the non-largest tumor was not associated with OS, R1 margin status relative to the largest index lesion was associated with prognosis.

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Acknowledgment

Georgios Antonios Margonis was supported by Bodossaki Foundation.

Disclosure

Kazunari Sasaki, Georgios A. Margonis, Kosuke Maitani, Nikolaos Andreatos, Jaeyun Wang, Emmanouil Pikoulis, Jin He, Christopher L. Wolfgang, Matthew Weiss, Timothy M. Pawlik have nothing to disclose.

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Author notes

  1. Kazunari Sasaki and Georgios A. Margonis contributed equally to this manuscript.

Authors and Affiliations

  1. Division of Surgical Oncology, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Kazunari Sasaki MD, Georgios A. Margonis MD, PhD, Kosuke Maitani MD, Nikolaos Andreatos MD, Jaeyun Wang BSc, Jin He MD, PhD, Christopher L. Wolfgang MD, PhD, Matthew Weiss MD & Timothy M. Pawlik MD, MPH, PhD

  2. First Department of Surgery, Laiko Hospital, University of Athens, Athens, Greece

    Emmanouil Pikoulis MD

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  1. Kazunari Sasaki MD
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  2. Georgios A. Margonis MD, PhD
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Correspondence to Timothy M. Pawlik MD, MPH, PhD.

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Sasaki, K., Margonis, G.A., Maitani, K. et al. The Prognostic Impact of Determining Resection Margin Status for Multiple Colorectal Metastases According to the Margin of the Largest Lesion. Ann Surg Oncol 24, 2438–2446 (2017). https://doi.org/10.1245/s10434-017-5904-5

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  • DOI: https://doi.org/10.1245/s10434-017-5904-5

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