Erschienen in:
31.05.2017 | Hepatobiliary Tumors
Positive Margins After Resection of Metastatic Colorectal Cancer in the Liver: Back to the Drawing Board?
verfasst von:
M. I. D’Angelica, MD, FACS
Erschienen in:
Annals of Surgical Oncology
|
Ausgabe 9/2017
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Excerpt
The debate over the relevance of surgical margins in patients undergoing hepatic resection for metastatic colorectal cancer has gone on for decades. For many years a “1-cm margin” rule was recommended. Based on limited and now outdated information, patients with margins closer than 1 cm appeared to have significantly worse survival. As recently as 10 years ago, our group continued to find better outcomes associated with margins greater than 1 cm.
1 More recently, most studies have found that beyond a 1-mm margin, there is no associated prolongation of survival. In fact, some groups have found that a positive margin does not matter at all, although these are typically reported in series where the margin positivity rate is as high as 50%.
2 To add more fuel to the fire, we recently found that compared to a true positive margin (malignant cells at the actual margin), even negative margins <1 mm were associated with improved survival.
3 One thing, however, is common throughout these myriad studies: in the context of multiple tumors, they all reported the surgical margin as that of the tumor with the closest margin. …
