Skip to main content

Advertisement

SpringerLink
Log in

Margin Status is Still an Important Prognostic Factor in Hepatectomies for Colorectal Liver Metastases: A Propensity Score Matching Analysis

  • Original Scientific Report
  • Published:
World Journal of Surgery Aims and scope Submit manuscript

Abstract

Objective

The width of resection margin is still a matter of debate in case of colorectal liver metastasis resection. The aim of this study was to determine the risk factors for R1 resection. Once risk factors had been identified, patients were matched according to Fong’s prognostic criteria, in order to evaluate whether R1 resection still remained a negative prognostic factor impacting overall and disease-free survival.

Methods

A total of 1784 hepatectomies were analyzed from a multicentric retrospective cohort of hepatectomies. Patients were compared before and after a 1:1 propensity score analysis in order to compare R0 versus R1 resections according to Fong criteria.

Results

Primary tumor nodes found positive after colorectal resection (RR = 1.20, p = 0.02), operative time (> 240 min) (RR = 1.26, p = 0.05), synchronous liver metastasis (RR = 1.27, p = 0.02), pedicle clamping (> 40 min) (RR = 1.52, p = 0.001), lesion size larger than 50 mm (RR = 1.54, p = 0.001), rehepatectomy (RR = 1.68, p = 0.001), more than 3 lesions (RR = 1.69, p = 0.0001), and bilateral lesions (RR = 1.74, p = 0.0001) were identified as risk factors in multivariate analysis. After a 1:1 PSM according to Fong criteria, R1 resection still remained a negative prognostic factor impacting overall and disease-free survival, with 1-, 3-, 5-year OS at 94, 81, and 70% in R0 and 92, 75, and 58% in R1, respectively, (p = 0.008), and disease-free survival (DFS) with 1-, 3-, 5-year survival at 64, 41, and 28% in R0 versus 51, 28, and 18% in R1 (p = 0.0002), respectively.

Conclusion

Even after using PSM as an oncological prognostic criterion, R1 resection still impacts overall and disease-free survival negatively.

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
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

Abbreviations

AFC:

Association Française de Chirurgie

ASA:

American Society of Anesthesiologists

BMI:

Body mass index

CEA:

Carcinoembryonic antigen

CRC:

Colorectal cancer

CRLM:

Colorectal liver metastases

DFI:

Disease-free interval

DFS:

Disease-free survival

OS:

Overall survival

PSM:

Propensity score matching

RR:

Relative risk

References

  1. Hamady ZZR, Lodge JPA, Welsh FK et al (2014) One-millimeter cancer-free margin is curative for colorectal liver metastases. Ann Surg 259:543–548. doi:10.1097/SLA.0b013e3182902b6e

    Article  PubMed  Google Scholar 

  2. Strasberg SM, Phillips C (2013) Use and dissemination of the brisbane 2000 nomenclature of liver anatomy and resections. Ann Surg 257:377–382. doi:10.1097/SLA.0b013e31825a01f6

    Article  PubMed  Google Scholar 

  3. Sadot E, Koerkamp BG, Leal JN et al (2015) Resection margin and survival in 2368 patients undergoing hepatic resection for metastatic colorectal cancer. Ann Surg 262:476–485. doi:10.1097/SLA.0000000000001427

    Article  PubMed  PubMed Central  Google Scholar 

  4. Pandanaboyana S, White A, Pathak S et al (2015) Impact of margin status and neoadjuvant chemotherapy on survival, recurrence after liver resection for colorectal liver metastasis. Ann Surg Oncol 22:173–179. doi:10.1245/s10434-014-3953-6

    Article  PubMed  Google Scholar 

  5. Nuzzo G, Giuliante F, Ardito F et al (2008) Influence of surgical margin on type of recurrence after liver resection for colorectal metastases: a single-center experience. Surgery 143:384–393. doi:10.1016/j.surg.2007.09.038

    Article  PubMed  Google Scholar 

  6. Elias D, Cavalcanti A, Sabourin JC et al (1998) Results of 136 curative hepatectomies with a safety margin of less than 10 mm for colorectal metastases. J Surg Oncol 69:88–93

    Article  CAS  PubMed  Google Scholar 

  7. Liu W, Sun Y, Zhang L, Xing B (2015) Negative surgical margin improved long-term survival of colorectal cancer liver metastases after hepatic resection: a systematic review and meta-analysis. Int J Colorectal Dis. doi:10.1007/s00384-015-2323-6

    Google Scholar 

  8. Fong Y, Fortner J, Sun RL et al (1999) Clinical score for predicting recurrence after hepatic resection for metastatic colorectal cancer: analysis of 1001 consecutive cases. Ann Surg 230:309–321. doi:10.1097/00000658-199909000-00004

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Nordlinger B, Sorbye H, Glimelius B et al (2013) Perioperative FOLFOX4 chemotherapy and surgery versus surgery alone for resectable liver metastases from colorectal cancer (EORTC 40983): long-term results of a randomised, controlled, phase 3 trial. Lancet Oncol 14:1208–1215. doi:10.1016/S1470-2045(13)70447-9

    Article  CAS  PubMed  Google Scholar 

  10. Welsh FKS, Tekkis PP, O’Rourke T et al (2008) Quantification of risk of a positive (R1) resection margin following hepatic resection for metastatic colorectal cancer: an aid to clinical decision-making. Surg Oncol 17:3–13. doi:10.1016/j.suronc.2007.12.003

    Article  PubMed  Google Scholar 

  11. Poultsides GA, Schulick RD, Pawlik TM (2010) Hepatic resection for colorectal metastases: the impact of surgical margin status on outcome. HPB (Oxf) 12:43–49. doi:10.1111/j.1477-2574.2009.00121.x

    Article  Google Scholar 

  12. Dematteo RP, Palese C, Jarnagin WR et al (2000) Anatomic segmental hepatic resection is superior to wedge resection as an oncologic operation for colorectal liver metastases. J Gastrointest Surg 4:178–184

    Article  CAS  PubMed  Google Scholar 

  13. Wray CJ, Lowy AM, Mathews JB et al (2005) The significance and clinical factors associated with a subcentimeter resection of colorectal liver metastases. Ann Surg Oncol 12:374–380. doi:10.1245/ASO.2005.06.038

    Article  CAS  PubMed  Google Scholar 

  14. Zorzi D, Mullen JT, Abdalla EK et al (2006) Comparison between hepatic wedge resection and anatomic resection for colorectal liver metastases. J Gastrointest Surg 10:86–94. doi:10.1016/j.gassur.2005.07.022

    Article  PubMed  Google Scholar 

  15. Puglisi F, Capuano P, Iambrenghi OC et al (2009) Laparoscopic repair of Morgagni hernia in an adult: use of a porcine small intestine submucosa biocompatible prosthesis. Chir Ital 61:351–356

    PubMed  Google Scholar 

  16. de’Angelis N, Memeo R, Calderaro J et al (2014) Open and laparoscopic resection of hepatocellular adenoma: trends over 23 years at a specialist hepatobiliary unit. HPB (Oxf) 16:783–788. doi:10.1111/hpb.12257

    Article  Google Scholar 

  17. Memeo R, de’Angelis N, Compagnon P et al (2014) Laparoscopic vs. open liver resection for hepatocellular carcinoma of cirrhotic liver: a case-control study. World J Surg 38:2919–2926. doi:10.1007/s00268-014-2659-z

    Article  PubMed  Google Scholar 

  18. Salloum C, Subar D, Memeo R et al (2013) Laparoscopic robotic liver surgery: the Henri Mondor initial experience of 20 cases. J Robot Surg. doi:10.1007/s11701-013-0437-9

    PubMed  Google Scholar 

  19. Ali MA, Di Sandro S, Lauterio A et al (2015) Repeat hepatectomy for recurrent colorectal liver metastases: is it worth the challenge? J Gastrointest Surg 19:2192–2198. doi:10.1007/s11605-015-2939-4

    Article  PubMed  Google Scholar 

  20. Sjoquist KM, Burmeister BH, Smithers BM et al (2011) Survival after neoadjuvant chemotherapy or chemoradiotherapy for resectable oesophageal carcinoma: an updated meta-analysis. Lancet Oncol 12:681–692. doi:10.1016/S1470-2045(11)70142-5

    Article  PubMed  Google Scholar 

  21. Markar SR, Bodnar A, Rosales J et al (2013) The impact of neoadjuvant chemoradiotherapy on perioperative outcomes, tumor pathology, and survival in clinical stage II and III esophageal cancer. Ann Surg Oncol 20:3935–3941. doi:10.1245/s10434-013-3137-9

    Article  PubMed  Google Scholar 

  22. Memeo R, de’Angelis N, de Blasi V, Cherkaoui Z, Brunetti O, Longo V, Piardi T, Sommacale D, Marescaux J, Mutter D, Pessaux P (2016) Innovative surgical approaches for hepatocellular carcinoma. World J Hepatol 8:591–596. doi:10.5662/wjm.v1.i1.4

    Article  PubMed  PubMed Central  Google Scholar 

  23. Ntourakis D, Memeo R, Soler L et al (2015) Augmented reality guidance for the resection of missing colorectal liver metastases: an initial experience. World J Surg. doi:10.1007/s00268-015-3229-8

    PubMed  Google Scholar 

Download references

Acknowledgements

The authors would like to thank all participating centers for their contribution to this study.

Author contributions

Amiens, CHU Amiens Picardie: Cyril Cosse, Delphine Lignier, Jean Marc Regimbeau; Angers, CHU Angers: Julien Barbieux, Emilie Lermite, Antoine Hamy; Beauvais, CH Beauvais: François Mauvais; Bordeaux, Groupe Hospitalier Saint André: Christophe Laurent; Chambery, CH Chambery: Irchid Al Naasan; Créteil, CHU Henri Mondor: Alexis Laurent, Daniel Azoulay, Philippe Compagnon, Nicola de’Angelis; Eaubonne, Hôpital Simone Veil: Mohammed Sbai Idrissi; Epinal, Polyclinique de la Ligne Bleue: Fréderic Martin; Gap, CH des Alpes du Sud: Jerôme Atger; Lyon, Hôpital de la Croix Rousse: Jacques Baulieux, Benjamin Darnis, Jean Yves; Mabrut; Lyon, Hôpital Edouart-Herriot: Vahan Kepenekian, Julie Perinel, Mustapha Adham; Lyon, CH Lyon Sud: Olivier Glehen; Lyon, Centre Léon Bérard: Michel Rivoire; Marseille, Hôpital de la Conception: Jean Hardwigsen, Anais Palen, Emilie Grégoire, Yves Patrice LeTreut; Marseille, Institut Paoli-Calmettes: Jean Robert Delpero, Olivier Turrini; Montpellier, Hôpital Saint Eloi: Astrid Herrero, Francis Navarro, Fabrizio Panaro; Nancy, CHU Brabois: Ahmet Ayav, Laurent Bresler; Nancy, Institut de Cancérologie de Lorraine Alexis-Vautrin: Philippe Rauch, François; Guillemin, Fréderic Marchal; Nice, Hôpital de l’Archet: Jean Gugenheim, Antonio Iannelli; Kremlin Bicêtre, CHU Kremlin Bicêtre: Stephane Benoist, Antoine Brouquet; Paris, Hôpital Lariboisière: Marc Pocard, Réa Lo Dico; Paris, Institut Mutualiste Montsouris: Brice Gayet, David Fuks; Paris, Hôpital Saint Antoine: Olivier. Scatton, Olivier Soubrane; Paris, Hôpital de la Pitié Salpetrière: Jean-Christophe Vaillant; Reims, Hôpital Robert Debré: Tullio Piardi, Daniel Sommacale, Reza Kianmanesh; La Roche-sur-Yon, Centre départemental de Vendée: Michel Comy; Strasbourg, Hôpital Hautepierre: Philippe Bachellier, Elie Oussoultzoglou, Pietro Addeo; Strasbourg, Nouvel Hôpital Civil: Dimitrios Ntourakis, Patrick Pessaux, Didier Mutter, Jacques Marescaux; Toulouse, Hôpital Rangueil: Loïc Raoux, Bertrand Suc, Fabrice Muscari; Troyes, Hôpital des Hauts-Clos: Georges ELHOMSY; Villejuif, Hôpital Paul Brousse: Maximiliano Gelli, Antonio Sa Cunha, René Adam, Denis Castaing, Daniel Cherqui; Gabriella Pittau, Oriana Ciacio, Eric Vibert; Villejuif, Gustave Roussy: Dominique Elias, Diane Goére, Fabrizio Vittadello.

Author information

Authors and Affiliations

  1. Institut Hospitalo-Universitaire (IHU), Institute for Minimally Invasive Hybrid Image-Guided Surgery, Université de Strasbourg, Strasbourg, France

    Riccardo Memeo, Vito de Blasi & Patrick Pessaux

  2. Institut de Recherche Contre les Cancers de l’Appareil Digestif (IRCAD), Strasbourg, France

    Riccardo Memeo, Vito de Blasi & Patrick Pessaux

  3. General, Digestive, and Endocrine Surgery, Nouvel Hôpital Civil, Strasbourg, France

    Riccardo Memeo, Vito de Blasi & Patrick Pessaux

  4. Department of Surgery, Hôpital Paul Brousse, Villejuif, France

    Rene Adam & Antonio Sa Cunha

  5. Department of Surgery, Institut Gustave Roussy, Villejuif, France

    Diane Goéré

  6. Department of Surgery, Hôpital Robert Debré, Reims, France

    Tullio Piardi

  7. Department of Surgery, CHU Angers, Angers, France

    Emilie Lermite

  8. Department of Surgery, Institut Paoli-Calmettes, Marseilles, France

    Olivier Turrini

  9. Department of Digestive Surgery, Université de Montpellier, Hôpital Saint-Eloi, Montpellier, France

    Francis Navarro

  10. Department of Surgery, Hopital Henri Mondor, Creteil, France

    Nicola de’Angelis

  11. HepatoBiliary and Pancreatic Surgery Department, 1, place de l’Hôpital, 67091, Strasbourg, France

    Patrick Pessaux

Authors
  1. Riccardo Memeo
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Vito de Blasi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Rene Adam
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Diane Goéré
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Tullio Piardi
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Emilie Lermite
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Olivier Turrini
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Francis Navarro
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Nicola de’Angelis
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Antonio Sa Cunha
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Patrick Pessaux
    View author publications

    You can also search for this author in PubMed Google Scholar

Consortia

French Colorectal Liver Metastases Working Group, Association Française de Chirurgie (AFC)

  • Cyril Cosse
  • , Delphine Lignier
  • , Jean Marc Regimbeau
  • , Julien Barbieux
  • , Emilie Lermite
  • , Antoine Hamy
  • , François Mauvais
  • , Christophe Laurent
  • , Irchid Al Naasan
  • , Alexis Laurent
  • , Daniel Azoulay
  • , Philippe Compagnon
  • , Nicola de’Angelis
  • , Mohammed Sbai Idrissi
  • , Fréderic Martin
  • , Jerôme Atger
  • , Jacques Baulieux
  • , Benjamin Darnis
  • , Jean Yves
  • ,  Mabrut
  • , Vahan Kepenekian
  • , Julie Perinel
  • , Mustapha Adham
  • , Olivier Glehen
  • , Michel Rivoire
  • , Jean Hardwigsen
  • , Anais Palen
  • , Emilie Grégoire
  • , Yves Patrice LeTreut
  • , Jean Robert Delpero
  • , Olivier Turrini
  • , Astrid Herrero
  • , Francis Navarro
  • , Fabrizio Panaro
  • , Ahmet Ayav
  • , Laurent Bresler
  • , Philippe Rauch
  • , François Guillemin
  • , Fréderic Marchal
  • , Jean Gugenheim
  • , Antonio Iannelli
  • , Stephane Benoist
  • , Antoine Brouquet
  • , Marc Pocard
  • , Réa Lo Dico
  • , Brice Gayet
  • , David Fuks
  • , Olivier. Scatton
  • , Olivier Soubrane
  • , Jean-Christophe Vaillant
  • , Tullio Piardi
  • , Daniel Sommacale
  • , Reza Kianmanesh
  • , Michel Comy
  • , Philippe Bachellier
  • , Elie Oussoultzoglou
  • , Pietro Addeo
  • , Dimitrios Ntourakis
  • , Patrick Pessaux
  • , Didier Mutter
  • , Jacques Marescaux
  • , Loïc Raoux
  • , Bertrand Suc
  • , Fabrice Muscari
  • , Georges ELHOMSY
  • , Maximiliano Gelli
  • , Antonio Sa Cunha
  • , René Adam
  • , Denis Castaing
  • , Daniel Cherqui
  • , Gabriella Pittau
  • , Oriana Ciacio
  • , Eric Vibert
  • , Dominique Elias
  • , Diane Goére
  •  & Fabrizio Vittadello

Corresponding author

Correspondence to Patrick Pessaux.

Ethics declarations

Conflict of interest

All authors declare that they have no conflict of interest.

Additional information

Collaborators of the French Surgical Association (Association Française de Chirurgie) Working Group are listed in acknowledgements.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Memeo, R., de Blasi, V., Adam, R. et al. Margin Status is Still an Important Prognostic Factor in Hepatectomies for Colorectal Liver Metastases: A Propensity Score Matching Analysis. World J Surg 42, 892–901 (2018). https://doi.org/10.1007/s00268-017-4229-7

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00268-017-4229-7

Search

Navigation