Pencovich Niv, Houli Rotem, Lubezky Nir, Goykhman Yaacov, Nakache Richard, Klausner Joseph M, Nachmany Ido
Department of General Surgery B, Division of Surgery, Tel-Aviv Sourasky Medical Center, The Nikolas & Elizabeth Shlezak Fund for Experimental Surgery, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
J Surg Oncol. 2019 Mar;119(3):347-354. doi: 10.1002/jso.25321. Epub 2018 Dec 12.
The impact of resection margins on the outcome of patients with colorectal liver metastasis (CRLM) remains controversial. We evaluated the short and long-term results of R1 resection.
Between 2006 and 2016, 202 patients underwent liver resection for CRLM. R1 resection was defined as a distance of less than 1 mm between tumor cells and the transection plain. Patient and tumor characteristics, perioperative, and long-term outcomes were assessed.
In 161 (79.7%) and 41 (20.3%) patients, an R0 and R1 resections were achieved, respectively. Patients that underwent an R1 resection had higher rates of disease progression while on chemotherapy (12.1% vs 5.5%, P = 0.001), need for second-line chemotherapy (17% vs 6.2%, P < 0.001), increased use of preoperative volume manipulation (14.6% vs 5.5%, P = 0.001), and inferior vena-cava involvement (21.9% vs 8.7%, P < 0.001). These patients had higher rates of major postoperative complications (19.5% vs 6.8%, P < 0.001) and reoperations (7.3% vs 2.4%, P < 0.001). Multivariate analysis demonstrated that R1 resections were not associated with decreased recurrence-free survival or overall survival.
Although R1 resection is associated with worse disease behavior and postoperative complications, the long-term outcome of patients following an R1 resection is non-inferior to those who underwent an R0 resection.
切缘对结直肠癌肝转移（CRLM）患者预后的影响仍存在争议。我们评估了R1切除的短期和长期结果。
2006年至2016年期间，202例患者因CRLM接受肝切除术。R1切除定义为肿瘤细胞与横断平面之间的距离小于1毫米。评估患者和肿瘤特征、围手术期及长期预后。
分别有161例（79.7%）和41例（20.3%）患者实现了R0和R1切除。接受R1切除的患者在化疗期间疾病进展率更高（12.1%对5.5%，P = 0.001），需要二线化疗的比例更高（17%对6.2%，P < 0.001），术前容积处理的使用率增加（14.6%对5.5%，P = 0.001），以及下腔静脉受累情况更严重（21.9%对8.7%，P < 0.001）。这些患者术后主要并发症发生率更高（19.5%对6.8%，P < 0.001），再次手术率更高（7.3%对2.4%，P < 0.001）。多变量分析表明，R1切除与无复发生存期或总生存期的降低无关。
尽管R1切除与更差的疾病行为和术后并发症相关，但R1切除患者的长期预后并不劣于接受R0切除的患者。
