Importance of resection margin after resection of colorectal liver metastases in the era of modern chemotherapy: population-based cohort study

Resection margin has been associated with overall survival following liver resection for colorectal liver metastasis. The aim of this study was to examine how resection margins of 0.0 mm, 0.1-0.9 mm and ≥1 mm influence overall survival in patients resected for colorectal liver metastasis in a time o...

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Published in:	BJS open Vol. 8; no. 3
Main Authors:	Östrand, Emil, Rystedt, Jenny, Engstrand, Jennie, Frühling, Petter, Hemmingsson, Oskar, Sandström, Per, Sternby Eilard, Malin, Tingstedt, Bobby, Buchwald, Pamela
Format:	Journal Article
Language:	English
Published:	England Oxford University Press 2024
Subjects:	Aged Aged, 80 and over Clinical Medicine Cohort Studies Colorectal Neoplasms - mortality Colorectal Neoplasms - pathology Female Hepatectomy Humans Kirurgi Klinisk medicin Liver Neoplasms - drug therapy Liver Neoplasms - mortality Liver Neoplasms - secondary Liver Neoplasms - surgery Male Margins of Excision Medical and Health Sciences Medicin och hälsovetenskap Middle Aged Original Proportional Hazards Models Registries Surgery Sweden - epidemiology Sweden
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Summary:	Resection margin has been associated with overall survival following liver resection for colorectal liver metastasis. The aim of this study was to examine how resection margins of 0.0 mm, 0.1-0.9 mm and ≥1 mm influence overall survival in patients resected for colorectal liver metastasis in a time of modern perioperative chemotherapy and surgery. Using data from the national registries Swedish Colorectal Cancer Registry and Swedish National Quality Registry for Liver, Bile Duct and Gallbladder Cancer, patients that had liver resections for colorectal liver metastasis between 2009 and 2013 were included. In patients with a narrow or unknown surgical margin the original pathological reports were re-reviewed. Factors influencing overall survival were analysed using a Cox proportional hazard model. A total of 754 patients had a known margin status, of which 133 (17.6%) patients had a resection margin <1 mm. The overall survival in patients with a margin of 0 mm or 0.1-0.9 mm was 42 (95% c.i. 31 to 53) and 48 (95% c.i. 35 to 62) months respectively, compared with 75 (95% c.i. 65 to 85) for patients with ≥1 mm margin, P < 0.001. Margins of 0 mm or 0.1-0.9 mm were associated with poor overall survival in the multivariable analysis, HR 1.413 (95% c.i. 1.030 to 1.939), P = 0.032, and 1.399 (95% c.i. 1.025 to 1.910), P = 0.034, respectively. Despite modern chemotherapy the resection margin is still an important factor for the survival of patients resected for colorectal liver metastasis, and a margin of ≥1 mm is needed to achieve the best possible outcome.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	2474-9842 2474-9842
DOI:	10.1093/bjsopen/zrae035