Department of Surgery, Division of Hepato-Biliary and Pancreatic Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea.
Department of Surgery, Division of Hepato-Biliary Pancreatic Surgery, King Saud Medical City, Riyadh, Saudi Arabia.
World J Surg Oncol. 2023 Jun 7;21(1):169. doi: 10.1186/s12957-023-03042-5.
A margin ≥ 1 mm is considered a standard resection margin for colorectal liver metastasis (CRLM). However, microscopic incomplete resection (R1) is not rare since aggressive surgical resection has been attempted in multiple and bilobar CRLM. This study aimed to investigate the prognostic impact of resection margins and perioperative chemotherapy in patients with CRLM.
A total of 368 of 371 patients who underwent simultaneous colorectal and liver resection for synchronous CRLM between 2006 and June 2017, excluding three R2 resections, were included in this study. R1 resection was defined as either abutting tumor on the resection line or involved margin in the pathological report. The patients were divided into R0 (n = 304) and R1 (n = 64) groups. The clinicopathological characteristics, overall survival, and intrahepatic recurrence-free survival were compared between the two groups using propensity score matching.
The R1 group had more patients with ≥ 4 liver lesions (27.3 vs. 50.0%, P < 0.001), higher mean tumor burden score (4.4 vs. 5.8%, P = 0.003), and more bilobar disease (38.8 vs. 67.2%, P < 0.001) than the R0 group. Both R0 and R1 groups showed similar long-term outcomes in the total cohort (OS, P = 0.149; RFS, P = 0.414) and after matching (OS, P = 0.097, RFS: P = 0.924). However, the marginal recurrence rate was higher in the R1 group than in the R0 group (26.6 vs. 16.1%, P = 0.048). Furthermore, the resection margin did not have a significant impact on OS and RFS, regardless of preoperative chemotherapy. Poorly differentiated, N-positive stage colorectal cancer, liver lesion number ≥ 4, and size ≥ 5 cm were poor prognostic factors, and adjuvant chemotherapy had a positive impact on survival.
The R1 group was associated with aggressive tumor characteristics; however, no effect on the OS and intrahepatic RFS with or without preoperative chemotherapy was observed in this study. Tumor biological characteristics, rather than resection margin status, determine long-term prognosis. Therefore, aggressive surgical resection should be considered in patients with CRLM expected to undergo R1 resection in this multidisciplinary approach era.
对于结直肠肝转移（CRLM），切缘≥1mm 被认为是标准的肝切除切缘。然而，由于在多个和双侧 CRLM 中尝试了积极的手术切除，因此不完全切除（R1）并不罕见。本研究旨在探讨 CRLM 患者的切缘和围手术期化疗的预后影响。
2006 年至 2017 年 6 月间，对同时接受结直肠和肝脏切除的 371 例同步 CRLM 患者中的 368 例（排除 3 例 R2 切除）进行了研究。R1 切除定义为切除线上紧贴肿瘤或病理报告中受累切缘。将患者分为 R0（n=304）和 R1（n=64）组。使用倾向评分匹配比较两组的临床病理特征、总生存期和肝内无复发生存期。
R1 组有更多的患者有≥4 个肝病变（27.3%比 50.0%，P<0.001）、更高的平均肿瘤负荷评分（4.4%比 5.8%，P=0.003）和更多的双侧疾病（38.8%比 67.2%，P<0.001）。R0 和 R1 两组在总队列中（OS，P=0.149；RFS，P=0.414）和匹配后（OS，P=0.097，RFS：P=0.924）均显示出相似的长期结果。然而，R1 组的边缘复发率高于 R0 组（26.6%比 16.1%，P=0.048）。此外，无论术前化疗如何，切缘均对 OS 和 RFS 无显著影响。低分化、N 阳性结直肠癌症、肝病变数量≥4 个和大小≥5cm 是不良预后因素，辅助化疗对生存有积极影响。
R1 组与侵袭性肿瘤特征相关；然而，在本研究中，无论是否进行术前化疗，均未观察到对 OS 和肝内 RFS 的影响。肿瘤生物学特征而不是切缘状态决定长期预后。因此，在多学科治疗时代，对于预计将行 R1 切除的 CRLM 患者，应考虑积极的手术切除。
