Recurrence at surgical margin following hepatectomy for colorectal liver metastases is not associated with R1 resection and does not impact survival
Recurrence at surgical margin following hepatectomy for colorectal liver metastases is not associated with R1 resection and does not impact survival
复制标题
DOI：
10.1016/j.surg.2020.11.024
复制
发表时间：
2021-05-04
期刊：
影响因子：
3.8
通讯作者：
Beldi, Guido
中科院分区：
文献类型：
--
作者：
Andreou, Andreas;Knitter, Sebastian;Beldi, Guido
背景资料：传统上，切除边缘状态与结直肠肝转移肝切除术后的肿瘤复发和肿瘤学结局相关。然而，以前的研究没有解决切除边缘对肿瘤复发部位的影响，也没有区分切除边缘的真正局部复发和肝脏其他部位的复发。本研究旨在确定是否积极的切除边缘决定局部复发和是否在手术边缘复发影响长期survival.Methods：2012年和2017年之间在2个主要肝胆中心（伯尔尼，瑞士和柏林，德国）接受根治性切除结直肠肝转移的患者的临床病理学数据和肿瘤学结果进行了评估。由两个中心的放射科医生审查肝切除术后的横断面成像，以区分切除边缘复发（定义为肝局部复发）和其他地方的肝内复发。手术切缘状态和肿瘤复发的位置之间的关联进行了评估，并对总生存率的影响进行了determined.Results：在研究期间，345例连续进行肝切除术结直肠癌肝转移。63例患者（18%）的组织学手术切缘肿瘤细胞（R1）呈阳性。中位随访时间为34个月后，154例患者（45%）发现肿瘤复发。与R 0切除术相比，R1切除术后肝局部复发率并没有更高（P = .555）。肝脏局部复发与总生存率不相关（P = 0.436），而R1状态显著损害总生存率（P = 0.025）。此外，肝局部复发患者与任何肝内和/或肝外复发患者的总生存期相同。仅肝内复发的患者，与仅接受化疗或最佳支持治疗的患者相比，如果可以进行局部肝治疗（切除或消融），肿瘤结局会得到改善（3年总生存率：85% vs 39%; P < .0001）。结论：结直肠癌肝转移肝切除术后肝局部复发的发生率与R1切除边缘状态无关。此外，与其他肝内或肝外复发相比，切缘肝局部复发与总生存率不相关。因此，肝切除术时的R1状态似乎是晚期疾病的替代因素，
Background: Resection margin status has traditionally been associated with tumor recurrence and oncological outcome following liver resection for colorectal liver metastases. Previous studies, however, did not address the impact of resection margin on the site of tumor recurrence and did not differentiate between true local recurrence at the resection margin and recurrence elsewhere in the liver. This study aimed to determine whether positive resection margins determine local recurrence and whether recurrence at the surgical margin influences long-term survival.Methods: Clinicopathological data and oncological outcomes of patients who underwent curative resection for colorectal liver metastases between 2012 and 2017 at 2 major hepatobiliary centers (Bern, Switzerland, and Berlin, Germany) were assessed. Cross-sectional imaging following hepatectomy was reviewed by radiologists in both centers to distinguish between recurrence at the resection margin, defined as hepatic local recurrence, and intrahepatic recurrence elsewhere. The association between surgical margin status and location of tumor recurrence was evaluated, and the impact on overall survival was determined.Results: During the study period, 345 consecutive patients underwent hepatectomy for colorectal liver metastases. Histologic surgical margins were positive for tumor cells (R1) in 63 patients (18%). After a median follow-up time of 34 months, tumor recurrence was identified in 154 patients (45%). Hepatic local recurrence was not detected more frequently after R1 than after R0 resection (P = .555). Hepatic local recurrence was not associated with worse overall survival (P = .436), while R1 status significantly impaired overall survival (P = .025). Additionally, overall survival was equivalent between patients with hepatic local recurrence and patients with any intrahepatic and/or extrahepatic recurrence. In patients with intrahepatic recurrence only, oncological outcomes improved if local hepatic therapy was possible (resection or ablation) in comparison to patients treated only with chemotherapy or best supportive care (3-year overall survival: 85% vs 39%; P < .0001).Conclusion: The incidence of hepatic local recurrence after hepatectomy for colorectal liver metastases is independent of R1 resection margin status. Additionally, hepatic local recurrence at the resection margin is not associated with worse overall survival compared with any other intra- or extrahepatic recurrence. Therefore, R1 status at hepatectomy seems to be a surrogate factor for advanced disease without