Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku,Yokohama 236-0004, Japan.
Eur J Surg Oncol. 2011 Apr;37(4):336-43. doi: 10.1016/j.ejso.2011.01.007. Epub 2011 Jan 31.
Here we reassess anticipated inability to obtain a microscopically clear surgical margin as an absolute contraindication to surgery for colorectal liver metastases in view of improvements in treatment modalities adjunctive to surgery.
We retrospectively analysed 310 patients treated at our institution to estimate the survival benefit from R1 hepatectomy performed to remove liver metastases from colorectal cancer.
Considering all 310 patients evaluated, the R1 resection group (positive margin; n = 55) showed a lower disease-free rate (P < 0.01) and worse overall survival (P < 0.01) than the R0 resection group (negative margin; n = 255). When patients were divided according to initial resectability, similar differences in disease-free rate and overall survival (P = 0.03) between R1 (n = 19) and R0 (n = 182) were observed in patients whose metastases were resectable. However, superior impact of R0 resection (n = 73) compared to R1 resection (n = 36) on disease-free rate (P = 0.44) and overall survival (P = 0.50) was not confirmed in patients with initially unresectable or marginally resectable metastases, especially those with a favourable response to prehepatectomy chemotherapy.
A predicted positive surgical margin after resection no longer should be an absolute contraindication to surgery for aggressive or advanced liver metastases.
鉴于手术辅助治疗方式的改进，我们重新评估了将无法获得显微镜下清晰手术切缘视为结直肠癌肝转移手术绝对禁忌证的预期。
我们回顾性分析了在我院治疗的 310 例患者，以评估对结直肠癌肝转移行 R1 肝切除术的生存获益。
考虑到所有 310 例患者，R1 切除组（阳性切缘；n=55）的无疾病生存率（P<0.01）和总生存率（P<0.01）均低于 R0 切除组（阴性切缘；n=255）。当根据初始可切除性对患者进行分组时，在可切除的转移患者中，R1 组（n=19）和 R0 组（n=182）之间无疾病生存率和总生存率（P=0.03）存在相似差异。然而，在最初不可切除或边缘可切除的转移患者中，尤其是对术前化疗有良好反应的患者中，R0 切除（n=73）与 R1 切除（n=36）相比，对无疾病生存率（P=0.44）和总生存率（P=0.50）的影响并不显著。
对于侵袭性或晚期肝转移，预测性的阳性手术切缘不再应成为手术的绝对禁忌证。
