Herman Paulo, Pinheiro Rafael S, Mello Evandro S, Lai Quirino, Lupinacci Renato M, Perini Marcos V, Pugliese Vincenzo, Andraus Wellington, Coelho Fabricio F, Cecconello Ivan, D'Albuquerque Luiz C
Arq Bras Cir Dig. 2013 Nov-Dec;26(4):309-14. doi: 10.1590/s0102-67202013000400011.
Approximately 50% of the patients with a colorectal tumor develop liver metastasis, for which hepatectomy is the standard care. Several prognostic factors have been discussed, among which is the surgical margin. This is a recurring issue, since no consensus exists as to the minimum required distance between the metastatic nodule and the liver transection line.
To evaluate the surgical margins in liver resections for colorectal metastases and their correlation with local recurrence and survival.
A retrospective study based on the review of the medical records of 91 patients who underwent resection of liver metastases of colorectal cancer. A histopathological review was performed of all the cases; the smallest surgical margin was verified, and the late outcome of recurrence and survival was evaluated.
No statistical difference was found in recurrence rates and overall survival between the patients with negative or positive margins (R0 versus R1); likewise, there was no statistical difference between subcentimeter margins and those greater than 1 cm. The disease-free survival of the patients with microscopically positive margins was significantly worse than that of the patients with negative margins. The uni- and multivariate analyses did not establish the surgical margin (R1, narrow or less than 1 cm) as a risk factor for recurrence.
The resections of liver metastases with negative margins, independently of the margin width, had no impact on tumor recurrence (intra- or extrahepatic) or patient survival.
约50%的结直肠肿瘤患者会发生肝转移，肝切除术是其标准治疗方法。已经讨论了几个预后因素，其中包括手术切缘。这是一个反复出现的问题，因为对于转移结节与肝切线之间所需的最小距离尚无共识。
评估结直肠癌肝转移灶切除术中的手术切缘及其与局部复发和生存的相关性。
一项回顾性研究，基于对91例行结直肠癌肝转移灶切除术患者的病历回顾。对所有病例进行组织病理学检查；核实最小手术切缘，并评估复发和生存的晚期结局。
切缘阴性或阳性（R0与R1）的患者之间在复发率和总生存率方面未发现统计学差异；同样，小于1厘米的切缘与大于1厘米的切缘之间也没有统计学差异。镜下切缘阳性患者的无病生存期明显低于切缘阴性患者。单因素和多因素分析均未将手术切缘（R1，狭窄或小于1厘米）确定为复发的危险因素。
切缘阴性的肝转移灶切除术，无论切缘宽度如何，对肿瘤复发（肝内或肝外）或患者生存均无影响。
