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Annals of Oncology Advance Access originally published online on April 13, 2007
Annals of Oncology 2007 18(7):1190-1195; doi:10.1093/annonc/mdm106
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© 2007 European Society for Medical Oncology

gastrointestinal tumors

Effect of subcentimeter nonpositive resection margin on hepatic recurrence in patients undergoing hepatectomy for colorectal liver metastases. Evidences from 663 liver resections

J Figueras1,*, F Burdio2,{dagger}, E Ramos2, J Torras2, L Llado2, S Lopez-Ben1, A Codina-Barreras1 and S Mojal3

1 Department of Surgery, Hospital de Girona "Josep Trueta", Girona
2 Department of Surgery, Bellvitge Hospital, Barcelona
3 Assessoria Metodològica en Investigació Biomèdica, Institut Municipal Investigacions Mediques, Barcelona, Spain

* Correspondence to: Dr J. Figueras, Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Hospital de Girona "Dr Josep Trueta", Crta de França s/n 17007 Girona, Spain. Tel: +34 972940256; Fax: +34 972940270; E-mail: info{at}jfigueras.net

Objective: To elucidate if a nonpositive <1-cm resection margin has any effect on hepatic recurrence in patients undergoing liver resection for colorectal liver metastases.

Patients and methods: Six hundred and nine patients underwent 663 liver resections. Patients with positive margin were excluded from the analysis. Two groups were studied: group A, <1-cm resection margin and group B, ≥1-cm resection margin.

Results: A total of 545 liver resections in 523 patients were carried out with nonpositive resection margins. With a median follow-up of 25 months, the 5-year cumulative hepatic recurrence reached 54% in group A (n = 206) and 41% in group B (n = 339). Factors associated with hepatic recurrence were synchronic metastases (P = 0.0015), bilobar (P < 0.001), two or more metastases (P < 0.001), margin <1 cm (P = 0.0123) and extrahepatic disease (P = 0.0037). A strong correlation between resection margin and number of metastases was confirmed (P < 0.001). At multivariate analysis only two factors were independent predictors of hepatic recurrence: multinodular disease in the liver specimen [≥4 metastases hazard ratio (HR) = 3.45; 95% confidence interval (CI): 2.2–5.38; P < 0.001] and extrahepatic disease at hepatectomy (HR = 1.58; 95% CI: 1.58–3.32).

Conclusion: Subcentimeter nonpositive resection margins do not directly influence hepatic recurrence in patients undergoing hepatectomy for colorectal liver metastases.

Key words: colorectal cancer, hepatectomy, liver metastases, liver neoplasms, liver surgery, resection margin

{dagger} Present address: Department of Surgery, Hospital del Mar, Barcelona, Spain.

Received for publication December 17, 2006. Revision received February 16, 2007. Accepted for publication February 19, 2007.


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