nach oben

International Journal of Colorectal Disease

Erschienen in:

01.10.2015 | Original Article

Negative surgical margin improved long-term survival of colorectal cancer liver metastases after hepatic resection: a systematic review and meta-analysis

verfasst von: Wei Liu, Yi Sun, Lei Zhang, Bao-Cai Xing

Erschienen in: International Journal of Colorectal Disease | Ausgabe 10/2015

Einloggen, um Zugang zu erhalten

Abstract

Objective

The need to achieve a tumor-free margin of ≥1 mm (R0) for colorectal liver metastases (CRLM) after hepatic resection has been questioned recently. This study conducted a meta-analysis to determine whether status of the surgical margin still influenced the long-term outcome of survival and recurrence rate.

Methods

Eligible trials that compared survival and recurrence rates of R0 versus the tumor-free margin <1 mm (R1) were identified from Embase, PubMed, the Web of Science, and the Cochrane Library since their inception to 1 March 2015. The study outcomes included long-term outcome of survival and recurrence rate. Hazard ratio (HR) with a 95 % confidence interval was used to measure the pooled effect according to a random-effects model or fixed-effects model, depending on the heterogeneity among the included studies. The heterogeneity among these trials was statistically evaluated using the χ ² and I ² tests. Sensitivity analyses and publication bias were also carried out.

Results

A total of 18 studies containing 6790 patients were included. The comparison between R1 and R0 revealed that a pooled HR for 5-year overall survival was 1.603 (95 % CI; 1.464–1.755; p = 0.000; I ² = 31.2 %, p = 0.141). For patients received modern chemotherapy; a pooled HR of R1 resection for 5-year overall survival was 1.924 (95 % CI; 1.567–2.361, p = 0.000; I ² = 20.5 %, p = 0.273). The pooled HR for 5-year OS of ≥1 cm in the included studies calculated using the random-effects model was 0.819 (95 % CI; 0.715–0.938, p = 0.004; I ² = 0 %, p = 0.492).

Conclusions

R1 resections decreased long-term survival, and modern chemotherapy did not alter an adverse outcome. Surgeons should attempt to obtain a 1-cm margin.

Nur mit Berechtigung zugänglich

Adam R, De Gramont A, Figueras J et al (2012) The oncosurgery approach to managing liver metastases from colorectal cancer: a multidisciplinary international consensus[J]. Oncologist 17(10):1225–1239PubMedCentralCrossRefPubMed

Vigano L, Russolillo N, Ferrero A et al (2012) Evolution of long-term outcome of liver resection for colorectal metastases: analysis of actual 5-year survival rates over two decades[J]. Ann Surg Oncol 19(6):2035–2044CrossRefPubMed

Spolverato G, Ejaz A, Azad N et al (2013) Surgery for colorectal liver metastases: the evolution of determining prognosis[J]. World J Gastrointest Oncol 5(12):207–221PubMedCentralCrossRefPubMed

Sugihara K, Uetake H (2012) Therapeutic strategies for hepatic metastasis of colorectal cancer: overview[J]. J Hepatobiliary Pancreat Sci 19(5):523–527CrossRefPubMed

Fong Y, Fortner J, Sun RL et al (1999) Clinical score for predicting recurrence after hepatic resection for metastatic colorectal cancer: analysis of 1001 consecutive cases[J]. Ann Surg 230(3):309–318, 318-321 PubMedCentralCrossRefPubMed

John SK, Robinson SM, Rehman S et al (2013) Prognostic factors and survival after resection of colorectal liver metastasis in the era of preoperative chemotherapy: an 11-year single-centre study[J]. Dig Surg 30(4–6):293–301CrossRefPubMed

Choti MA, Sitzmann JV, Tiburi MF et al (2002) Trends in long-term survival following liver resection for hepatic colorectal metastases[J]. Ann Surg 235(6):759–766PubMedCentralCrossRefPubMed

Bodingbauer M, Tamandl D, Schmid K et al (2007) Size of surgical margin does not influence recurrence rates after curative liver resection for colorectal cancer liver metastases[J]. Br J Surg 94(9):1133–1138CrossRefPubMed

Inoue Y, Hayashi M, Komeda K et al (2012) Resection margin with anatomic or nonanatomic hepatectomy for liver metastasis from colorectal cancer[J]. J Gastrointest Surg 16(6):1171–1180CrossRefPubMed

10.

Muratore A, Ribero D, Zimmitti G et al (2010) Resection margin and recurrence-free survival after liver resection of colorectal metastases[J]. Ann Surg Oncol 17(5):1324–1329CrossRefPubMed

11.

Hamady ZZ, Cameron IC, Wyatt J et al (2006) Resection margin in patients undergoing hepatectomy for colorectal liver metastasis: a critical appraisal of the 1cm rule[J]. Eur J Surg Oncol 32(5):557–563CrossRefPubMed

12.

Sb W G (2009) Newcastle-Ottawa Scale (NOS) for assessing the quality if non-randomized studies in meta-analyses[Z]

13.

Tierney JF, Stewart LA, Ghersi D et al (2007) Practical methods for incorporating summary time-to-event data into meta-analysis[J]. Trials 8:16PubMedCentralCrossRefPubMed

14.

Dersimonian R, Laird N (1986) Meta-analysis in clinical trials[J]. Control Clin Trials 7(3):177–188CrossRefPubMed

15.

Andreou A, Aloia TA, Brouquet A et al (2013) Margin status remains an important determinant of survival after surgical resection of colorectal liver metastases in the era of modern chemotherapy[J]. Ann Surg 257(6):1079–1088PubMedCentralCrossRefPubMed

16.

Angelsen JH, Horn A, Eide GE et al (2014) Surgery for colorectal liver metastases: the impact of resection margins on recurrence and overall survival[J]. World J Surg Oncol 12:127PubMedCentralCrossRefPubMed

17.

Are C, Gonen M, Zazzali K et al (2007) The impact of margins on outcome after hepatic resection for colorectal metastasis[J]. Ann Surg 246(2):295–300PubMedCentralCrossRefPubMed

18.

Ayez N, Lalmahomed ZS, Eggermont AM et al (2012) Outcome of microscopic incomplete resection (R1) of colorectal liver metastases in the era of neoadjuvant chemotherapy[J]. Ann Surg Oncol 19(5):1618–1627PubMedCentralCrossRefPubMed

19.

de Haas RJ, Wicherts DA, Flores E et al (2008) R1 resection by necessity for colorectal liver metastases: is it still a contraindication to surgery?[J]. Ann Surg 248(4):626–637PubMed

20.

Eveno C, Karoui M, Gayat E et al (2013) Liver resection for colorectal liver metastases with peri-operative chemotherapy: oncological results of R1 resections[J]. HPB (Oxford) 15(5):359–364CrossRef

21.

Kokudo N, Miki Y, Sugai S et al (2002) Genetic and histological assessment of surgical margins in resected liver metastases from colorectal carcinoma: minimum surgical margins for successful resection[J]. Arch Surg 137(7):833–840CrossRefPubMed

22.

Margonis G A, Spolverato G, Kim Y, et al (2014) Intraoperative Surgical Margin Re-resection for Colorectal Liver Metastasis: Is It Worth the Effort?[J]. J Gastrointest Surg

23.

Minagawa M, Makuuchi M, Torzilli G et al (2000) Extension of the frontiers of surgical indications in the treatment of liver metastases from colorectal cancer: long-term results[J]. Ann Surg 231(4):487–499PubMedCentralCrossRefPubMed

24.

Montalti R, Tomassini F, Laurent S, et al (2014) Impact of surgical margins on overall and recurrence-free survival in parenchymal-sparing laparoscopic liver resections of colorectal metastases[J]. Surg Endosc

25.

Nuzzo G, Giuliante F, Ardito F et al (2008) Influence of surgical margin on type of recurrence after liver resection for colorectal metastases: a single-center experience[J]. Surgery 143(3):384–393CrossRefPubMed

26.

Pandanaboyana S, White A, Pathak S et al (2015) Impact of margin status and neoadjuvant chemotherapy on survival, recurrence after liver resection for colorectal liver metastasis[J]. Ann Surg Oncol 22(1):173–179CrossRefPubMed

27.

Pawlik TM, Scoggins CR, Zorzi D et al (2005) Effect of surgical margin status on survival and site of recurrence after hepatic resection for colorectal metastases[J]. Ann Surg 241(5):715–722, 722-724 PubMedCentralCrossRefPubMed

28.

Tranchart H, Chirica M, Faron M et al (2013) Prognostic impact of positive surgical margins after resection of colorectal cancer liver metastases: reappraisal in the era of modern chemotherapy[J]. World J Surg 37(11):2647–2654CrossRefPubMed

29.

Truant S, Sequier C, Leteurtre E et al (2015) Tumour biology of colorectal liver metastasis is a more important factor in survival than surgical margin clearance in the era of modern chemotherapy regimens[J]. HPB (Oxford) 17(2):176–184

30.

Wakai T, Shirai Y, Sakata J et al (2008) Appraisal of 1 cm hepatectomy margins for intrahepatic micrometastases in patients with colorectal carcinoma liver metastasis[J]. Ann Surg Oncol 15(9):2472–2481CrossRefPubMed

31.

Pawlik TM, Vauthey JN (2008) Surgical margins during hepatic surgery for colorectal liver metastases: complete resection not millimeters defines outcome[J]. Ann Surg Oncol 15(3):677–679PubMedCentralCrossRefPubMed

32.

Ribero D, Vigano L, Amisano M et al (2013) Prognostic factors after resection of colorectal liver metastases: from morphology to biology[J]. Future Oncol 9(1):45–57CrossRefPubMed

33.

Nordlinger B, Sorbye H, Glimelius B et al (2008) Perioperative chemotherapy with FOLFOX4 and surgery versus surgery alone for resectable liver metastases from colorectal cancer (EORTC Intergroup trial 40983): a randomised controlled trial[J]. Lancet 371(9617):1007–1016PubMedCentralCrossRefPubMed

34.

Tzeng CW, Aloia TA (2013) Colorectal liver metastases[J]. J Gastrointest Surg 17(1):195–201, 201-202 CrossRefPubMed

35.

Tanaka K, Nojiri K, Kumamoto T et al (2011) R1 resection for aggressive or advanced colorectal liver metastases is justified in combination with effective prehepatectomy chemotherapy[J]. Eur J Surg Oncol 37(4):336–343CrossRefPubMed

36.

Dematteo RP, Palese C, Jarnagin WR et al (2000) Anatomic segmental hepatic resection is superior to wedge resection as an oncologic operation for colorectal liver metastases[J]. J Gastrointest Surg 4(2):178–184CrossRefPubMed

37.

Welsh FK, Tekkis PP, O’Rourke T et al (2008) Quantification of risk of a positive (R1) resection margin following hepatic resection for metastatic colorectal cancer: an aid to clinical decision-making[J]. Surg Oncol 17(1):3–13CrossRefPubMed

38.

Poultsides GA, Schulick RD, Pawlik TM (2010) Hepatic resection for colorectal metastases: the impact of surgical margin status on outcome[J]. HPB (Oxford) 12(1):43–49CrossRef

39.

Petrelli NJ (2008) Perioperative or adjuvant therapy for resectable colorectal hepatic metastases[J]. J Clin Oncol 26(30):4862–4863CrossRefPubMed

40.

Nakajima Y, Nagao M, Ko S et al (2001) Clinical predictors of recurrence site after hepatectomy for metastatic colorectal cancer[J]. Hepatogastroenterology 48(42):1680–1684PubMed

41.

D’Angelica M, Kornprat P, Gonen M et al (2011) Effect on outcome of recurrence patterns after hepatectomy for colorectal metastases[J]. Ann Surg Oncol 18(4):1096–1103CrossRefPubMed

42.

Farid SG, Aldouri A, Morris-Stiff G et al (2010) Correlation between postoperative infective complications and long-term outcomes after hepatic resection for colorectal liver metastasis[J]. Ann Surg 251(1):91–100CrossRefPubMed

43.

Ng JK, Urbanski SJ, Mangat N et al (2008) Colorectal liver metastases contract centripetally with a response to chemotherapy: a histomorphologic study[J]. Cancer 112(2):362–371CrossRefPubMed

44.

Nanko M, Shimada H, Yamaoka H et al (1998) Micrometastatic colorectal cancer lesions in the liver[J]. Surg Today 28(7):707–713CrossRefPubMed

45.

Elias D, Bonnet S, Honore C et al (2008) Comparison between the minimum margin defined on preoperative imaging and the final surgical margin after hepatectomy for cancer: how to manage it?[J]. Ann Surg Oncol 15(3):777–781CrossRefPubMed

46.

Wicherts DA, de Haas RJ, Salloum C et al (2013) Repeat hepatectomy for recurrent colorectal metastases[J]. Br J Surg 100(6):808–818CrossRefPubMed

47.

Shaw IM, Rees M, Welsh FK et al (2006) Repeat hepatic resection for recurrent colorectal liver metastases is associated with favourable long-term survival[J]. Br J Surg 93(4):457–464CrossRefPubMed

Titel: Negative surgical margin improved long-term survival of colorectal cancer liver metastases after hepatic resection: a systematic review and meta-analysis
verfasst von: Wei Liu
Yi Sun
Lei Zhang
Bao-Cai Xing
Publikationsdatum: 01.10.2015
Verlag: Springer Berlin Heidelberg
Erschienen in: International Journal of Colorectal Disease / Ausgabe 10/2015
Print ISSN: 0179-1958
Elektronische ISSN: 1432-1262
DOI: https://doi.org/10.1007/s00384-015-2323-6

Neu im Fachgebiet Chirurgie

Welche Übungen helfen gegen Diastase recti abdominis?

30.04.2024 Schwangerenvorsorge Nachrichten

Die Autorinnen und Autoren einer aktuellen Studie aus Griechenland sind sich einig, dass Bewegungstherapie, einschließlich Übungen zur Stärkung der Bauchmuskulatur und zur Stabilisierung des Rumpfes, eine Diastase recti abdominis postpartum wirksam reduzieren kann. Doch vieles ist noch nicht eindeutig belegt.

Wie erfolgreich ist eine Re-Ablation nach Rezidiv?

23.04.2024 Ablationstherapie Nachrichten

Nach der Katheterablation von Vorhofflimmern kommt es bei etwa einem Drittel der Patienten zu Rezidiven, meist binnen eines Jahres. Wie sich spätere Rückfälle auf die Erfolgschancen einer erneuten Ablation auswirken, haben Schweizer Kardiologen erforscht.

Hinter dieser Appendizitis steckte ein Erreger

23.04.2024 Appendizitis Nachrichten

Schmerzen im Unterbauch, aber sonst nicht viel, was auf eine Appendizitis hindeutete: Ein junger Mann hatte Glück, dass trotzdem eine Laparoskopie mit Appendektomie durchgeführt und der Wurmfortsatz histologisch untersucht wurde.

Mehr Schaden als Nutzen durch präoperatives Aussetzen von GLP-1-Agonisten?

23.04.2024 Operationsvorbereitung Nachrichten

Derzeit wird empfohlen, eine Therapie mit GLP-1-Rezeptoragonisten präoperativ zu unterbrechen. Eine neue Studie nährt jedoch Zweifel an der Notwendigkeit der Maßnahme.

Update Chirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Aktuelle BDC Leitlinien-Webinare

S3-Leitlinie „Diagnostik und Therapie des Karpaltunnelsyndroms“

Karpaltunnelsyndrom BDC Leitlinien Webinare

CME: 2 Punkte

Das Karpaltunnelsyndrom ist die häufigste Kompressionsneuropathie peripherer Nerven. Obwohl die Anamnese mit dem nächtlichen Einschlafen der Hand (Brachialgia parästhetica nocturna) sehr typisch ist, ist eine klinisch-neurologische Untersuchung und Elektroneurografie in manchen Fällen auch eine Neurosonografie erforderlich. Im Anfangsstadium sind konservative Maßnahmen (Handgelenksschiene, Ergotherapie) empfehlenswert. Bei nicht Ansprechen der konservativen Therapie oder Auftreten von neurologischen Ausfällen ist eine Dekompression des N. medianus am Karpaltunnel indiziert.

Prof. Dr. med. Gregor Antoniadis

S2e-Leitlinie „Distale Radiusfraktur“

Radiusfraktur BDC Leitlinien Webinare

CME: 2 Punkte

Das Webinar beschäftigt sich mit Fragen und Antworten zu Diagnostik und Klassifikation sowie Möglichkeiten des Ausschlusses von Zusatzverletzungen. Die Referenten erläutern, welche Frakturen konservativ behandelt werden können und wie. Das Webinar beantwortet die Frage nach aktuellen operativen Therapiekonzepten: Welcher Zugang, welches Osteosynthesematerial? Auf was muss bei der Nachbehandlung der distalen Radiusfraktur geachtet werden?

PD Dr. med. Oliver Pieske

Dr. med. Benjamin Meyknecht

S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“

Appendizitis BDC Leitlinien Webinare

CME: 2 Punkte

Inhalte des Webinars zur S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“ sind die Darstellung des Projektes und des Erstellungswegs zur S1-Leitlinie, die Erläuterung der klinischen Relevanz der Klassifikation EAES 2015, die wissenschaftliche Begründung der wichtigsten Empfehlungen und die Darstellung stadiengerechter Therapieoptionen.

Dr. med. Mihailo Andric

Springer Medizin

Abstract

Objective

Methods

Results

Conclusions

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 10/2015

Letter to the editor: one point cancer of ileal adenocarcinoma complicated from Crohn’s disease

Doublet chemotherapy vs. single-agent therapy with 5FU in elderly patients with metastatic colorectal cancer. a meta-analysis

Visceral fat accumulation affects risk of colonic diverticular hemorrhage

How many segments are necessary to characterize delayed colonic transit time?

Two different gracilis loops in graciloplasty of congenital fecal incontinence: comparison of the therapeutic effects

A randomized trial to compare the efficacy and tolerability of sodium picosulfate-magnesium citrate solution vs. 4 L polyethylene glycol solution as a bowel preparation for colonoscopy

Update Chirurgie