Skip to main content

Advertisement

SpringerLink
Log in

Long-Term Survival Benefit and Potential for Cure after R1 Resection for Colorectal Liver Metastases

  • Hepatobiliary Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Although efficient chemotherapy regimens have improved outcomes after R1 resection (positive margins) for colorectal liver metastases (CLMs), the long-term survival benefit and potential for cure after R1 resection have not been clearly demonstrated. The aim of this study was to evaluate the long-term outcome after R1 resection for CLM, and to identify factors predictive of cure.

Methods

All resected CLM patients at our institution from 2000 to 2009 were prospectively evaluated. Cure was defined as a disease-free interval ≥5 years from the last hepatic or extrahepatic resection to last follow-up.

Results

Of 628 patients consecutively resected for CLM, 428 were eligible for the study, of whom 219 (51 %) underwent R0 resection (negative margins) and 209 (49 %) underwent R1 resection. Overall, 130 patients with R0 resection and 141 patients with R1 resection had more than 5 years of follow-up. Five- and 10-year overall survival rates were 56 and 34 % for R0 patients, and 48 and 36 % for R1 patients, respectively (p = 0.37). Of the 141 patients who underwent R1 resection, 26 patients (18 %) were considered ‘cured’, and 106 patients (75 %) were considered ‘noncured’. Independent predictive factors of cure after R1 resection included ≤10 total cycles of preoperative chemotherapy and objective response to preoperative chemotherapy.

Conclusions

Overall, potential cure can be achieved in 18 % of patients after R1 resection for CLM. The best conditions to achieve long-term survival after R1 resection rely on a good response to efficient and short first-line chemotherapy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. de Hass RJ, Wicherts DA, Flores E, et al. R1 resection by necessity for colorectal liver metastases: is it still a contraindication to surgery? Ann Surg. 2008;248:626–37.

    Google Scholar 

  2. Ekberg H, Tranberg KG, Andersson R, et al. Determinants of survival in liver resection for colorectal secondaries. Br J Surg. 1986;73:727–31.

    Article  CAS  PubMed  Google Scholar 

  3. Shirabe K, Takenaka K, Gion T, et al. Analysis of prognostic risk factors in hepatic resection for metastatic colorectal carcinoma with special reference to the surgical margin. Br J Surg. 1997;84:1077–80.

    Article  CAS  PubMed  Google Scholar 

  4. Cady B, Jenkins RL, Steele GD Jr, et al. Surgical margin in hepatic resection for colorectal metastasis: a critical and improvable determinant of outcome. Ann Surg. 1998;227:566–71.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Ng JK, Urbanski SJ, Mangat N, et al. Colorectal liver metastases contact centripetally with a response to chemotherapy: a histomorphologic study. Cancer. 2008;112:362–71.

    Article  CAS  PubMed  Google Scholar 

  6. Kokudo N, Miki Y, Sugai S, et al. Genetic and histological assessment of surgical margins in resected liver metastases from colorectral carcinoma: minimum surgical margins for successful resection. Arch Surg. 2002;137:833–40.

    Article  PubMed  Google Scholar 

  7. Pawlik TM, Scoggins CR, Zorzi D, et al. Effect of surgical margin status on survival and site of recurrence after hepatic resection for colorectal metastases. Ann Surg. 2005;241:715–24.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Andreou A, Aloia T, Brouquet A, et al. Margin status remains an important determinant of survival after surgical resection of colorectal liver metastases in the era of modern chemotherapy. Ann Surg. 2013;257:1079–88.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Margonis GA, Spolverato G, Kim Y, et al. Intraoperative surgical margin re-resection for colorectal liver metastasis: is it worth the effort? J Gastrointest Surg. 2015;13:872–80.

    Google Scholar 

  10. Tranchart H, Chirica M, Faron M, et al. Prognostic impact of positive surgical margins after resection of colorectal cancer liver metastases: reappraisal in the era of modern chemotherapy. World J Surg. 2013;37:2647–54.

    Article  PubMed  Google Scholar 

  11. Adam R, Laurent A, Azoulay D, et al. Two-stage hepatectomy: a planned strategy to treat irresectable liver tumors. Ann Surg. 2000;232:777–85.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Schadde E, Ardiles V, Robles-Campos R, et al. Early survival and safety of ALPPS: first report of the international ALPPS registry. Ann Surg. 2014;260:829–38.

    Article  PubMed  Google Scholar 

  13. Adam R, de Hass RJ, Wicherts DA, et al. Concomitant extrahepatic disease in patients with colorectal liver metastases: when is there a place for surgery? Ann Surg. 2011;253:349–59.

    Article  PubMed  Google Scholar 

  14. Adam R, Pascal G, Castaing D, et al. Tumor progression while on chemotherapy: a contraindication to liver resection for multiple colorectal metastases? Ann Surg. 2004;240:1052–61.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Adam R, Delvart V, Pascal G, et al. Rescue surgery for unresectable colorectal liver metastases downstaged by chemotherapy: a model to predict long-term survival. Ann Surg. 2004;240:644–57.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Adam R, Hoti E, Bredt LC, et al. Evolution of neoadjuvant therapy for extended hepatic metastases: have we reached our (non-resectable) limit? J Surg Oncol. 2010;102:922–31.

    Article  PubMed  Google Scholar 

  17. Adam R, de Gramont A, Figueras J, et al. The oncosurgery approach to managing liver metastases from colorectal cancer: a multidisciplinary international consensus. Oncologist. 2012;17:1225–39.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Therasse P, Arbuck SG, Eisenhauer EA, et al. New guidelines to evaluate the response to treatment in solid tumors. European Organization for Research and Treatment of Cancer, National Cancer Institute of the United States, National Cancer Institute of Canada. J Natl Cancer Inst. 2000;92:205–16.

    Article  CAS  PubMed  Google Scholar 

  19. Eisenhauer EA, Therasse P, Bogaerts J, et al. New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1). Eur J Cancer. 2009;45:228–47.

    Article  CAS  PubMed  Google Scholar 

  20. Adam R, Wicherts DA, de Haas RJ, et al. Patients with initially unresectable colorectal liver metastases: is there a possibility of cure? J Clin Oncol. 2009;27:1829–35.

    Article  PubMed  Google Scholar 

  21. Goere D, Malka D, Tzanis D, et al. Is there a possibility of a cure in patients with colorectal peritoneal carcinomatosis amenable to complete cytoreductive surgery and intraperitoneal chemotherapy? Ann Surg. 2013;257:1065–71.

    Article  PubMed  Google Scholar 

  22. Sadot E, Koerkamp BG, Leal JN, et al. Resection margin and survival in 2368 patients undergoing hepatic resection for metastatic colorectal cancer: surgical technique of biologic surrogate? Ann Surg. 2015;262:476–85.

    Article  PubMed  Google Scholar 

  23. Hamady ZZ, Lodge JP, Welsh FK, et al. One-millimeter cancer-free margin is curative for colorectal liver metastases: a propensity score case-match approach. Ann Surg. 2014;259:543–8.

    Article  PubMed  Google Scholar 

  24. Viagnò L, Capussotti L, Barroso E, et al. Progression while receiving preoperative chemotherapy should not be an absolute contraindication to liver resection for colorectal metastases. Ann Surg Oncol. 2012;19:2786–96.

    Article  Google Scholar 

  25. Tomlinson JS, Jarnagin WR, DeMatteo RP, et al. Actual 10-year survival after resection of colorectal liver metastases define cure. J Clin Oncol. 2007;25:4575–80.

    Article  PubMed  Google Scholar 

Download references

Conflict of interest

All authors declare no conflicts of interest.

Author information

Authors and Affiliations

  1. Centre Hépato-Biliaire, AP-HP Hôpital Paul Brousse, Villejuif, France

    Isamu Hosokawa MD, PhD, Marc-Antoine Allard MD, Maximiliano Gelli MD, Oriana Ciacio MD, Eric Vibert MD, PhD, Daniel Cherqui MD, Antonio Sa Cunha MD, Denis Castaing MD & René Adam MD, PhD

  2. Department of General Surgery, Chiba University Graduate School of Medicine, Chiba, Japan

    Isamu Hosokawa MD, PhD & Masaru Miyazaki MD, PhD

Authors
  1. Isamu Hosokawa MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Marc-Antoine Allard MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Maximiliano Gelli MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Oriana Ciacio MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Eric Vibert MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Daniel Cherqui MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Antonio Sa Cunha MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Denis Castaing MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Masaru Miyazaki MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. René Adam MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to René Adam MD, PhD.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOC 125 kb)

10434_2015_5060_MOESM2_ESM.tif

Difference between time to last unresectable recurrence and recurrence-free survival(RFS) of patients after R1 resection, demonstrating the effect of repeat surgery. Supplementary material 2 (TIFF 71 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Hosokawa, I., Allard, MA., Gelli, M. et al. Long-Term Survival Benefit and Potential for Cure after R1 Resection for Colorectal Liver Metastases. Ann Surg Oncol 23, 1897–1905 (2016). https://doi.org/10.1245/s10434-015-5060-8

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-015-5060-8

Keywords

Search

Navigation