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Relevance of chemotherapy and margin status in colorectal liver metastasis

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Abstract

Purpose

This retrospective, single-center study aimed to investigate the importance of chemotherapy and to come up with the optimal liver resection margin length for patients with resectable colorectal liver metastasis (CRLM).

Methods

Patients who had undergone any form of liver resection for CRLM were reviewed and analyzed. The analyses were broken down into three parts: (1) overall effect of chemotherapy, (2) effect of chemotherapy with positive/negative resection margin, and (3) result of discriminative analysis with optimal margin length analysis.

Results

In total, 381 patients were studied. Among them, 279 received chemotherapy whereas 102 did not. Survival was significantly better in patients with chemotherapy (5-year, 43.6% vs. 25.8%) (p < 0.001). Patients who received chemotherapy (n = 93) with negative margins had better survival than patients (n = 8) with positive margins (5-year, 28.1% vs. 0%) (p = 0.019). On multivariate analysis, margin involvement was the poor prognostic factor for survival. Patients who had chemotherapy (n = 238) with negative margin showed a trend of better survival than patients (n = 41) with positive margins (5-year, 45.7% vs. 29.3%) (p = 0.085). Patients (n = 93) with negative margin and no chemotherapy and patients (n = 41) with positive margin and chemotherapy had comparable survival at 5 years (p = 0.422). On multivariate analysis, tumor number was the prognostic factor for survival. By the discriminant method, 1.09 cm (sensitivity 0.242, specificity 0.718) was determined as the cut-off for optimal margin length. Patients who had margin ≥ 1.09 cm (n = 81) enjoyed significantly better survival (5-year, 54.3% vs. 33.5%) (p = 0.041). On multivariate analysis, margin length ≥ 1.09 cm was the prognostic factor for favorable survival.

Conclusion

The results demonstrated the important effect of perioperative chemotherapy and negative margin liver resection in management of patients suffered from CRLM.

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Acknowledgements

The authors would like to thank Mr. Kim Yuen (BSc (Hons), Stat and Comp) for all the statistical work for the study.

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Authors and Affiliations

  1. Department of Surgery, The University of Hong Kong, 102 Pok Fu Lam Road, Hong Kong, China

    Wong Hoi She, Tan To Cheung, Ka Wing Ma, Simon H. Y. Tsang, Wing Chiu Dai, Albert C. Y. Chan & Chung Mau Lo

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  1. Wong Hoi She
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  2. Tan To Cheung
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Contributions

She WH was responsible for study design, literature search, collection, analysis and interpretation of data, and manuscript drafting; Cheung TT was responsible for study design, analysis and interpretation of data, and writing and critical revision of manuscript; Ma KW, Tsang SHY, Dai WC, and Chan ACY were responsible for study design and critical revision of manuscript; Lo CM was responsible for study design; Cheung TT is the guarantor.

Corresponding author

Correspondence to Tan To Cheung.

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This article does not contain any studies with animals performed by any of the authors. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The use of the data set was previously approved by the Ethics Committee of the Queen Mary Hospital of the University of Hong Kong. Informed consent was obtained from all individual participants included in the study. Due to the nature of this retrospective analysis, further institutional approval was not necessary.

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The authors declare no competing interests.

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She, W.H., Cheung, T.T., Ma, K.W. et al. Relevance of chemotherapy and margin status in colorectal liver metastasis. Langenbecks Arch Surg 406, 2725–2737 (2021). https://doi.org/10.1007/s00423-021-02205-w

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  • DOI: https://doi.org/10.1007/s00423-021-02205-w

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