Department of Digestive and Hepatobiliary Surgery, AP-HP, Henri Mondor University Hospital, Créteil, France.
HPB (Oxford). 2013 May;15(5):359-64. doi: 10.1111/j.1477-2574.2012.00581.x. Epub 2012 Oct 22.
Retrospective analysis of outcomes of R0 (negative margin) versus R1 (positive margin) liver resections for colorectal metastases (CLM) in the context of peri-operative chemotherapy.
All CLM resections between 2000 and 2006 were reviewed. Exclusion criteria included: macroscopically incomplete (R2) resections, the use of local treatment modalities, the presence of extra-hepatic disease and no peri-operative chemotherapy. R0/R1 status was based on pathological examination.
Of 86 eligible patients, 63 (73%) had R0 and 23 (27%) had R1 resections. The two groups were comparable for the number, size of metastases and type of hepatectomy. The R1 group had more bilobar CLM (52% versus 24%, P = 0.018). The median follow-up was 3.1 years. Five-year overall and disease-free survival were 54% and 21% for the R0 group and 49% and 22% for the R1 group (P = 0.55 and P = 0.39, respectively). An intra-hepatic recurrence was more frequent in the R1 group (52% versus 27%, P = 0.02) and occurred more frequently at the surgical margin (22% versus 3%, P = 0.01).
R1 resections were associated with a higher risk of intra-hepatic and surgical margin recurrence but did not negatively impact survival suggesting that in the era of efficient chemotherapy, the risk of an R1 resection should not be considered as a contraindication to surgery.
在围手术期化疗的背景下,对结直肠癌肝转移(CLM)行 R0(阴性切缘)与 R1(阳性切缘)肝切除术的结果进行回顾性分析。
回顾分析了 2000 年至 2006 年间所有的 CLM 切除术。排除标准包括:肉眼下不完全切除(R2)、局部治疗方法的应用、肝外疾病的存在和无围手术期化疗。R0/R1 状态基于病理检查。
86 例符合条件的患者中,63 例(73%)为 R0 切除,23 例(27%)为 R1 切除。两组患者的转移灶数量、大小和肝切除术类型相似。R1 组中双侧 CLM 更多(52%比 24%,P = 0.018)。中位随访时间为 3.1 年。R0 组的 5 年总生存率和无病生存率分别为 54%和 21%,R1 组分别为 49%和 22%(P = 0.55 和 P = 0.39)。R1 组肝内复发更常见(52%比 27%,P = 0.02),且更常发生于手术切缘(22%比 3%,P = 0.01)。
R1 切除术与肝内和手术切缘复发风险增加相关,但未对生存产生负面影响,这表明在化疗有效的时代,不应将 R1 切除术的风险视为手术的禁忌证。