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Impact of surgical margins on overall and recurrence-free survival in parenchymal-sparing laparoscopic liver resections of colorectal metastases

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Abstract

Background

The relationship between the width of surgical margins and local and distant recurrence of colorectal liver metastases (CRLM) remain controversial. We analyzed the impact of surgical margins in laparoscopic liver resections (LLR) for CRLM, using the parenchymal-sparing approach on overall (OS) and recurrence-free survival (RFS).

Methods

From January 2005 to October 2012, 114 first LLR for CRLM were performed and retrospectively analyzed. The ultrasonic aspirator was used for parenchyma division. R1 margins were defined when the tissue width was <1 mm.

Results

After a mean follow-up of 30.9 ± 1.71 months, OS was 97.1–73.9–58.9 % and the RFS 64.2–35.2–31 % at 1–3–5 years, respectively. The major resection rate was 7 %. The median margin width was 3 (0–40) mm, and R1 resection was recorded in 14 (12.3 %) cases. Twenty-two patients (33.3 %) with hepatic recurrence underwent a repeat hepatectomy. R1 margins were significantly related to lower RFS survival (p = 0.038) but did not affect OS. Multivariate analysis showed that lesions located in postero-superior segments (HR = 2.4, 95 % CI 1.24–4.61, p = 0.009) as well as blood loss (HR = 3.2, 95 % CI 1.23–7.99, p = 0.012) were independent risk factors for tumor recurrence. The carcinoembryonic antigen level >10 mcg/L affected OS (HR = 4.2 95 % CI 2.02–16.9, p = 0.001), and the resection of more than two tumors was significantly associated with R1 margins (HR = 9.32, 95 % CI 1.14–32.5, p = 0.037).

Discussion

Laparoscopic parenchymal-sparing surgery of CRLM does not compromise the oncological outcome, allowing a higher percentage of repeat hepatectomy. R1 margins are a risk factor for tumor recurrence but not for overall survival. The presence of multiple lesions is the only independent risk factor of R1 margins and also the major disadvantage of this technique.

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Disclosures

Roberto Montalti, Federico Tomassini, Stéphanie Laurent, Peter Smeets, Marc De Man, Karen Geboes, Louis J. Libbrecht, and Roberto I. Troisi declared that they have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Department of General & Hepato-Biliary Surgery, Liver Transplantation Service, Ghent University Hospital and Medical School, De Pintelaan 185, 2K12 IC, 9000, Ghent, Belgium

    Roberto Montalti, Federico Tomassini & Roberto I. Troisi

  2. Department of Oncology, Ghent University Hospital and Medical School, De Pintelaan 185, 9000, Ghent, Belgium

    Stéphanie Laurent, Marc De Man & Karen Geboes

  3. Department of Pathology, Ghent University Hospital and Medical School, De Pintelaan 185, 9000, Ghent, Belgium

    Louis J. Libbrecht

  4. Department of Radiology, Ghent University Hospital and Medical School, De Pintelaan 185, 9000, Ghent, Belgium

    Peter Smeets

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  1. Roberto Montalti
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Correspondence to Roberto I. Troisi.

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Montalti, R., Tomassini, F., Laurent, S. et al. Impact of surgical margins on overall and recurrence-free survival in parenchymal-sparing laparoscopic liver resections of colorectal metastases. Surg Endosc 29, 2736–2747 (2015). https://doi.org/10.1007/s00464-014-3999-3

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