Angelsen Jon-Helge, Horn Arild, Eide Geir Egil, Viste Asgaut
Department of Acute and Digestive Surgery, Haukeland University Hospital, N-5021 Bergen, Norway.
World J Surg Oncol. 2014 Apr 27;12:127. doi: 10.1186/1477-7819-12-127.
Several reports have presented conflicting results regarding the association between resection margins (RMs) and outcome after surgery for colorectal liver metastases (CLM), especially in the era of modern chemotherapy. The purpose of this study was to evaluate the impact of RMs on overall survival (OS), time to recurrence (TTR) and local recurrence (LR) status, particularly for patients treated with preoperative chemotherapy.
A combined retrospective (1998 to 2008) and prospective (2008 to 2010) cohort study of consecutive patients with CLM without extrahepatic disease treated with primary resection at a medium volume centre.
A total of 253 patients with known R status and 242 patients with defined margin width were included in the study. Patients were stratified according to margin width; A: R1, <1 mm (n=48, 19%), B: 1 to 4 mm (n=77), C: 5 to 9 mm (n=46) and D: ≥10 mm (n=71). Median time to recurrence was 12.8 months, and after five years 21.5% had no recurrence. LR (inclusive combined recurrence in other hepatic sites or extrahepatic) occurred in 40 (16.5%) cases, most frequently seen with RMs below 5 mm. Five-year OS was 42.5% in R0 and 16.1% in R1 resections (P=0.011). Patients were also stratified according to preoperative chemotherapy (n=88), and the difference in five-year OS between R0 (45.1%) and R1 (14.7%) was maintained (P=0.037). By multiple Cox regression analysis R1 resections tended to an adverse outcome (P=0.067), also when adjusting for preoperative chemotherapy (P=0.081).
R1 resections for colorectal liver metastases predict adverse outcome. RMs below 5 mm increased the risk for LR and shortened the time to recurrence. Preoperative chemotherapy did not alter an adverse outcome in R1 vs. R0 patients.
关于结直肠癌肝转移（CLM）手术切除边缘（RMs）与术后结局之间的关联，已有多篇报道呈现出相互矛盾的结果，尤其是在现代化疗时代。本研究的目的是评估RMs对总生存期（OS）、复发时间（TTR）和局部复发（LR）状态的影响，特别是对于接受术前化疗的患者。
一项对在中等规模中心接受初次切除的无肝外疾病的CLM连续患者进行的回顾性（1998年至2008年）和前瞻性（2008年至2010年）队列研究。
共有253例已知R状态的患者和242例明确边缘宽度的患者纳入研究。患者根据边缘宽度分层；A：R1，<1mm（n = 48，19%），B：1至4mm（n = 77），C：5至9mm（n = 46），D：≥10mm（n = 71）。中位复发时间为12.8个月，5年后21.5%的患者无复发。40例（16.5%）出现LR（包括其他肝部位或肝外的联合复发），最常见于RMs小于5mm的情况。R0切除的5年总生存率为42.5%，R1切除为16.1%（P = 0.011）。患者也根据术前化疗情况（n = 88）进行分层，R0（45.1%）和R1（14.7%）之间5年总生存率的差异仍然存在（P = 0.037）。通过多因素Cox回归分析，R1切除倾向于不良结局（P = 0.067），在调整术前化疗后也是如此（P = 0.081）。
结直肠癌肝转移的R1切除预示不良结局。RMs小于5mm会增加LR风险并缩短复发时间。术前化疗并未改变R1与R0患者的不良结局。
