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Impact of resection margins for colorectal liver metastases in laparoscopic and open liver resection: a propensity score analysis

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Abstract

Background

There is no clear consensus over the optimal width of resection margin for colorectal liver metastases (CRLM), with evolving definitions alongside the advances on the management of the disease. In addition, data on the impact of resection margin after laparoscopic liver resection are still scarce.

Methods

Prospectively maintained databases of patients undergoing open or laparoscopic CRLM resection in 7 European tertiary hepatobiliary referral centres were reviewed. After propensity score matching (PSM), the influence of 1 mm and wider margins on OS and DFS were evaluated in open and laparoscopic cohorts.

Results

After PSM, 648 patients were comparable in each group. The incidence of positive margins (< 1 mm) was similar in open and laparoscopic groups (17% vs 13%, p = 0,142).

Margins < 1 mm were associated with shorter RFS in open (12 vs 26 months, p = 0.042) and in laparoscopic group (13 vs 23, p = 0,002). Margins < 1 mm were associated with shorter OS in open (36 vs 57 months, p = 0.027), but not in laparoscopic group (49 vs 60, p = 0,177).

Subgroups with margins ≥ 1 mm (1–4 mm, 5–9 mm, ≥ 10 mm) presented similar RFS in open (p = 0,251) or laparoscopic cohorts (p = 0.117), as well as similar OS in open (p = 0.295) or laparoscopic cohorts (p = 0.908). In the presence of liver recurrence, repeat liver resection was performed in 70 (30%) patients in the open group and 88 (48%) in the laparoscopic group (p < 0.001).

Conclusions

Our study suggests that a positive resection margin (less than 1 mm) width does not impact OS after laparoscopic resection of CRLMs as it does in open liver resection. However, a positive margin continues to affect RFS in open and laparoscopic resection. Wider margins than 1 mm do not seem to improve oncological results in open or laparoscopic surgery.

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Authors and Affiliations

  1. Department of Hepatobiliary and Pancreatic Surgery, University Hospital Southampton NHS Foundation Trust, E Level Tremona Road, Southampton, SO16 6YD, UK

    David Martínez-Cecilia, Dennis A. Wicherts & Mohammad Abu Hilal

  2. Department of Surgery, Hepatobiliary Surgery Unit, San Raffaele Scientific Institute, Milan, Italy

    Federica Cipriani & Luca Aldrighetti

  3. Department of General, Hepatobiliary and Liver Transplantation Surgery, Ghent University Hospital Medical School, Ghent, Belgium

    Giammauro Berardi & Roberto I. Troisi

  4. Department of Hepatic, Pancreatic and Biliary Surgery, Leader Professor at The Intervention Centre, Oslo University Hospital, Oslo, Norway

    Leonid Barkhatov & Bjorn Edwin

  5. Institute of Clinical Medicine, Oslo, Norway

    Leonid Barkhatov & Bjorn Edwin

  6. Department of Digestive Minimally Invasive Surgery, Antoine Béclère Hospital, Paris, France

    Panagiotis Lainas & Ibrahim Dagher

  7. Department of Digestive and Hepatobiliary/Pancreatic Surgery, Groeninge Hospital, Kortrijk, Belgium

    Mathieu D’Hondt

  8. Department of General and Digestive Surgery, Clinica Universidad de Navarra, Pamplona, Spain

    Fernando Rotellar

  9. Department of Hepatobiliary Surgery, Hospital Universitario de Toledo, Toledo, Spain

    David Martínez-Cecilia

  10. Department of Hepato-Biliary and Pancreatic Surgery, Instituto Fondazione Poliambulanza, Brescia, Italy

    Mohammad Abu Hilal

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  1. David Martínez-Cecilia
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Correspondence to David Martínez-Cecilia.

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Disclosures

David Martínez-Cecilia, Dennis A. Wicherts, Federica Cipriani, Giammauro Berardi, Leonid Barkhatov, Panagiotis Lainas, Mathieu D’Hondt, Fernando Rotellar, Ibrahim Dagher, Luca Aldrighetti, Roberto I. Troisi, Bjorn Edwin, and Mohammad Abu Hilal have no conflicts of interest or financial ties to disclose.

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464_2020_7452_MOESM1_ESM.docx

Supplementary file1 (DOCX 411 kb)—Supplementary figure A. Histogram of propensity score before and after propensity score matchingSupplementary figure B. Histogram of standardized differences before and after propensity score matchingSupplementary figure C: Evolution of patients under open and laparoscopic approach after propensity score matching.

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Martínez-Cecilia, D., Wicherts, D.A., Cipriani, F. et al. Impact of resection margins for colorectal liver metastases in laparoscopic and open liver resection: a propensity score analysis. Surg Endosc 35, 809–818 (2021). https://doi.org/10.1007/s00464-020-07452-4

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  • DOI: https://doi.org/10.1007/s00464-020-07452-4

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