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Impact of microscopic incomplete resection for colorectal liver metastases on surgical margin recurrence: R1-Contact
Fabio Ausania1, Filippo Landi1, Aleix Martínez-Pérez2
1Department of General and Digestive Surgery, Hospital Clínic, Universidad de Barcelona, IDIBAPS, Barcelona, Spain.
Journal of Hepato-Biliary-Pancreatic Sciences
|January 7, 2022
Summary
R1-contact margins in colorectal cancer liver metastases surgery are linked to higher surgical margin recurrence and poorer survival outcomes. This finding emphasizes the importance of achieving negative margins for better patient prognosis.
Area of Science:
- Oncology
- Surgical Oncology
- Gastroenterology
Background:
- R1 resection in colorectal cancer liver metastases (CRLM) is associated with inferior patient outcomes.
- The specific impact of directly involved margins (R1-contact) versus margins less than 1 mm (R1 < 1 mm) on recurrence and survival remains unclear.
Purpose of the Study:
- To analyze the impact of R1-contact versus R1 < 1 mm margins on surgical margin recurrence (SMR) in patients undergoing liver resection for CRLM.
- To compare recurrence rates and survival outcomes between these two R1 resection groups.
Main Methods:
- A cohort of 77 patients with R1 resections for CRLM between 2009-2018 were identified and categorized into R1-contact (53 patients) and R1 < 1 mm (24 patients) groups.
- Recurrence rates, disease-free survival (DFS), and disease-specific survival (DSS) were compared between the groups.
- Univariate and multivariate analyses were performed to identify factors associated with SMR.
Main Results:
- The overall recurrence rate was 79.2%, with no significant difference between R1 < 1 mm (70.8%) and R1-contact (83%) groups (P = .222).
- However, the R1-contact group showed significantly poorer median DFS (55 months vs 93 months; P = .025) and DSS (46 months vs 69 months; P = .038) compared to the R1 < 1 mm group.
- The SMR rate was significantly higher in the R1-contact group (30.2% vs 8.3%; P = .036).
- Multivariate analysis identified R1-contact margin as the sole independent factor associated with higher SMR (OR = 5.6; P = .046).
Conclusions:
- R1-contact margins are independently associated with increased surgical margin recurrence after liver resection for CRLM.
- Patients with R1-contact margins experience significantly worse disease-free and disease-specific survival.
- Achieving negative margins, specifically avoiding direct tumor contact, is crucial for improving outcomes in CRLM surgery.
