Resection Margin and Recurrence-Free Survival After Liver Resection of Colorectal Metastases
Resection Margin and Recurrence-Free Survival After Liver Resection of Colorectal Metastases
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DOI：
10.1245/s10434-009-0770-4
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发表时间：
2010-05-01
影响因子：
3.7
通讯作者：
Capussotti, Lorenzo
中科院分区：
文献类型：
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作者：
Muratore, Andrea;Ribero, Dario;Capussotti, Lorenzo
最佳边际宽度是不确定的，因为最近的研究以总体存活率为终点，得出了相互矛盾的结果。复发后，再次切除和积极化疗严重影响生存时间；这些因素的潜在混杂作用尚未被调查。使用无复发生存期(RFS)可以克服这一限制。本研究的目的是评估切除切缘宽度对结直肠癌肝切除术后的远期疗效和复发部位的影响。从前瞻性维护的机构数据库(1999年1月至2007年12月)中，我们确定了314例接受肝切除术的结直肠转移瘤患者(1999年1月至2007年12月)，对手术切缘进行了详细的病理分析，并记录了疾病状态和复发部位的完整随访影像研究，这些患者被分类为：切除切缘(M(Arg))、其他肝内((其他)IH)、肺(L)或其他肝外((其他)EH)。无复发评估为生存终点，中位随访时间为56.5个月。215例(68.8%)患者平均15.5个月后在288个部位复发。切缘阳性与M(精氨酸)复发风险增加相关(P<；0.001)。千分之二转移率的存在是增加正切缘风险的唯一因素(P<；0.05)。阴性切缘宽度(1/1000日元比1厘米)不是RFS恶化的预后因素(30.2%比37.3%，P=0.6)。原发肿瘤的结节状态、CRM的大小和数目是影响RFS的独立预测因素。肿瘤生物学而不是阴性切除切缘的宽度影响RFS。
Optimal margin width is uncertain because of conflicting results from recent studies using overall survival as the end-point. After recurrence, re-resection and aggressive chemotherapy heavily affect survival time; the potential confounding effect of such factors has not been investigated. Use of recurrence-free survival (RFS) may overcome this limitation. The aim of this study is to evaluate the impact of width of resection margin on RFS and site of recurrence after hepatic resection for colorectal metastases (CRM).From a prospectively maintained institutional database (1/1999-12/2007) we identified 314 patients undergone hepatectomy for CRM (1/1999-12/2007) with detailed pathologic analysis of the surgical margin and complete follow-up imaging studies documenting disease status and site of recurrence, which was categorized as: resection margin (M(arg)), other intra-hepatic ((other)IH), lung (L) or other extra-hepatic ((other)EH). Recurrence-free estimation was the survival end-point.Median follow-up was 56.5 months. Two hundred and fifteen patients (68.8%) recurred at 288 sites after a mean of 15.5 months. A positive resection margin was associated with an increased risk of M(arg) recurrence (P < 0.001). The presence of a parts per thousand yen2 metastases was the only factor increasing the risk of positive margins (P < 0.05). The width of the negative resection margin (a parts per thousand yen1 cm versus > 1 cm) was not a prognostic factor of worse RFS (30.2% versus 37.3%, P = 0.6). Node status of the primary tumour, and size and number of CRM were independent predictors of RFS.Tumour biology and not the width of the negative resection margin affect RFS.