Baron Thomas, Laroche Sophie, Wagner Mathilde, Lim Chetana, Renaud Florence, Charlotte Frederic, Scatton Olivier, Goumard Claire
Hepatobiliary Surgery and Liver Transplantation Department, Sorbonne University, Pitié Salpêtrière Hospital, Paris, France.
Radiology Department, Sorbonne University, Pitié Salpêtrière Hospital, Paris, France.
Surgery. 2025 May;181:109137. doi: 10.1016/j.surg.2024.109137. Epub 2025 Jan 28.
Histologic microscopic positive resection margin is a debated prognostic factor in patients resected for colorectal liver metastases. This study aimed to assess whether patients with R1 resection experience recurrence at the site of the resection (on-site recurrence) and to identify predictive factors for recurrence profiles in patients with R1 margins after resection of colorectal liver metastases.
All surgical colorectal liver metastasis resection cases with R1 parenchymal margin from September 2014 to March 2020 in our center were retrospectively included. Imaging was reviewed for each metastasis. All the analyses were performed per metastasis. Recurrence location was examined for each metastasis according to the site of the R1 margin and defined as on-site when recurrence was at the same place of the resected lesion. Prognostic factors for recurrence type were assessed using logistic regression.
Of 700 patients who underwent liver resection for colorectal liver metastases, 105 (15%) had at least 1 metastasis with R1 resection margin, representing 6.8% per metastasis. The median follow-up was 34 months. Overall recurrence occurred in 130 metastases (83.3%) with intrahepatic recurrence in 106 metastases (80.9%). On-site recurrence was observed for 49 metastases (31.4%) and isolated (without an additional recurrence site) for 20 metastases (12.8%). The on-site recurrence did not impact overall survival. Three predictive factors for on-site recurrence were found in the multivariate logistic regression: synchronous metastases, nonanatomic resection, and pathologic response tumor regression grade 4-5.
Intrahepatic localization of recurrence is more frequent than on-site recurrence after R1 parenchymal resection. Synchronous metastases, nonanatomic resection, and tumor regression grade 4-5 may impact the risk of on-site recurrence.
组织学显微镜下切缘阳性是接受结直肠癌肝转移切除术患者中一个存在争议的预后因素。本研究旨在评估R1切除的患者是否会在切除部位出现复发（原位复发），并确定结直肠癌肝转移切除术后R1切缘患者复发模式的预测因素。
回顾性纳入2014年9月至2020年3月在本中心进行的所有具有R1实质切缘的结直肠癌肝转移手术切除病例。对每个转移灶进行影像学检查。所有分析均按转移灶进行。根据R1切缘部位检查每个转移灶的复发位置，当复发位于切除病变的同一部位时定义为原位复发。使用逻辑回归评估复发类型的预后因素。
在700例行结直肠癌肝转移肝切除术的患者中，105例（15%）至少有1个转移灶切缘为R1，每个转移灶的比例为6.8%。中位随访时间为34个月。130个转移灶（83.3%）发生总体复发，106个转移灶（80.9%）发生肝内复发。观察到49个转移灶（31.4%）原位复发，20个转移灶（12.8%）孤立复发（无其他复发部位）。原位复发不影响总生存期。多因素逻辑回归发现了三个原位复发的预测因素：同时性转移、非解剖性切除和病理反应肿瘤退缩分级4 - 5级。
R1实质切除术后肝内复发的定位比原位复发更常见。同时性转移、非解剖性切除和肿瘤退缩分级4 - 5级可能影响原位复发风险。
