Effect of surgical margin status on survival and site of recurrence after hepatic resection for colorectal metastases

Timothy M. Pawlik, Charles R. Scoggins, Daria Zorzi, Eddie K. Abdalla, Axel Andres, Cathy Eng, Steven A. Curley, Evelyne M. Loyer, Andrea Muratore, Gilles Mentha, Lorenzo Capussotti, Jean Nicolas Vauthey, Michael A. Choti, Reid B. Adams, John S. Bolton, Alan W. Hemming, Joseph B. Cofer, W. Roy Smythe, Bryan M. Clary, Jean Nicolas Vauthey

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Abstract

Objective: To evaluate the influence of surgical margin status on survival and site of recurrence in patients treated with hepatic resection for colorectal metastases. Methods: Using a multicenter database, 557 patients who underwent hepatic resection for colorectal metastases were identified. Demographics, operative data, pathologic margin status, site of recurrence (margin, other intrahepatic site, extrahepatic), and long-term survival data were collected and analyzed. Results: On final pathologic analysis, margin status was positive in 45 patients, and negative by 1 to 4 mm in 129, 5 to 9 mm in 85, and ≥1 cm in 298. At a median follow-up of 29 months, the 1-, 3-, and 5-year actuarial survival rates were 97%, 74%, and 58%; median survival was 74 months. Tumor size ≥5 cm, >3 tumor nodules, and carcinoembryonic antigen level >200 ng/mL predicted poor survival (all P < 0.05). Median survival was 49 months in patients with positive margins and not yet reached in patients with negative margins (P = 0.01). After hepatic resection, 225 (40.4%) patients had recurrence: 21 at the surgical margin, 56 at another intrahepatic site, 82 at an extrahepatic site, and 66 at both intrahepatic and extrahepatic sites. Patients with negative margins of 1 to 4 mm, 5 to 9 mm, and ≥1 cm had similar overall recurrence rates (P > 0.05). Patients with positive margins were more likely to have surgical margin recurrence (P = 0.003). Adverse preoperative biologic factors including tumor number greater than 3 (P = 0.01) and a preoperative CEA level greater than 200 ng/mL (P = 0.04) were associated with an increased risk of positive surgical margin. Conclusions: A positive margin after resection of hepatic colorectal metastases is associated with adverse biologic factors and increased risk of surgical-margin recurrence. The width of a negative surgical margin does not affect survival, recurrence risk, or site of recurrence. A predicted margin of <1 cm after resection of hepatic colorectal metastases should not be used as an exclusion criterion for resection.

Original languageEnglish (US)
Pages (from-to)715-724
Number of pages10
JournalAnnals of Surgery
Volume241
Issue number5
DOIs
StatePublished - May 2005

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Neoplasm Metastasis
Recurrence
Survival
Liver
Biological Factors
Carcinoembryonic Antigen
Neoplasm Antigens
Margins of Excision
Neoplasms
Survival Rate
Demography
Databases

ASJC Scopus subject areas

  • Surgery

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Pawlik, T. M., Scoggins, C. R., Zorzi, D., Abdalla, E. K., Andres, A., Eng, C., ... Vauthey, J. N. (2005). Effect of surgical margin status on survival and site of recurrence after hepatic resection for colorectal metastases. Annals of Surgery, 241(5), 715-724. https://doi.org/10.1097/01.sla.0000160703.75808.7d

Effect of surgical margin status on survival and site of recurrence after hepatic resection for colorectal metastases. / Pawlik, Timothy M.; Scoggins, Charles R.; Zorzi, Daria; Abdalla, Eddie K.; Andres, Axel; Eng, Cathy; Curley, Steven A.; Loyer, Evelyne M.; Muratore, Andrea; Mentha, Gilles; Capussotti, Lorenzo; Vauthey, Jean Nicolas; Choti, Michael A.; Adams, Reid B.; Bolton, John S.; Hemming, Alan W.; Cofer, Joseph B.; Smythe, W. Roy; Clary, Bryan M.; Vauthey, Jean Nicolas.

In: Annals of Surgery, Vol. 241, No. 5, 05.2005, p. 715-724.

Research output: Contribution to journalArticle

Pawlik, TM, Scoggins, CR, Zorzi, D, Abdalla, EK, Andres, A, Eng, C, Curley, SA, Loyer, EM, Muratore, A, Mentha, G, Capussotti, L, Vauthey, JN, Choti, MA, Adams, RB, Bolton, JS, Hemming, AW, Cofer, JB, Smythe, WR, Clary, BM & Vauthey, JN 2005, 'Effect of surgical margin status on survival and site of recurrence after hepatic resection for colorectal metastases', Annals of Surgery, vol. 241, no. 5, pp. 715-724. https://doi.org/10.1097/01.sla.0000160703.75808.7d
Pawlik, Timothy M. ; Scoggins, Charles R. ; Zorzi, Daria ; Abdalla, Eddie K. ; Andres, Axel ; Eng, Cathy ; Curley, Steven A. ; Loyer, Evelyne M. ; Muratore, Andrea ; Mentha, Gilles ; Capussotti, Lorenzo ; Vauthey, Jean Nicolas ; Choti, Michael A. ; Adams, Reid B. ; Bolton, John S. ; Hemming, Alan W. ; Cofer, Joseph B. ; Smythe, W. Roy ; Clary, Bryan M. ; Vauthey, Jean Nicolas. / Effect of surgical margin status on survival and site of recurrence after hepatic resection for colorectal metastases. In: Annals of Surgery. 2005 ; Vol. 241, No. 5. pp. 715-724.
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title = "Effect of surgical margin status on survival and site of recurrence after hepatic resection for colorectal metastases",
abstract = "Objective: To evaluate the influence of surgical margin status on survival and site of recurrence in patients treated with hepatic resection for colorectal metastases. Methods: Using a multicenter database, 557 patients who underwent hepatic resection for colorectal metastases were identified. Demographics, operative data, pathologic margin status, site of recurrence (margin, other intrahepatic site, extrahepatic), and long-term survival data were collected and analyzed. Results: On final pathologic analysis, margin status was positive in 45 patients, and negative by 1 to 4 mm in 129, 5 to 9 mm in 85, and ≥1 cm in 298. At a median follow-up of 29 months, the 1-, 3-, and 5-year actuarial survival rates were 97{\%}, 74{\%}, and 58{\%}; median survival was 74 months. Tumor size ≥5 cm, >3 tumor nodules, and carcinoembryonic antigen level >200 ng/mL predicted poor survival (all P < 0.05). Median survival was 49 months in patients with positive margins and not yet reached in patients with negative margins (P = 0.01). After hepatic resection, 225 (40.4{\%}) patients had recurrence: 21 at the surgical margin, 56 at another intrahepatic site, 82 at an extrahepatic site, and 66 at both intrahepatic and extrahepatic sites. Patients with negative margins of 1 to 4 mm, 5 to 9 mm, and ≥1 cm had similar overall recurrence rates (P > 0.05). Patients with positive margins were more likely to have surgical margin recurrence (P = 0.003). Adverse preoperative biologic factors including tumor number greater than 3 (P = 0.01) and a preoperative CEA level greater than 200 ng/mL (P = 0.04) were associated with an increased risk of positive surgical margin. Conclusions: A positive margin after resection of hepatic colorectal metastases is associated with adverse biologic factors and increased risk of surgical-margin recurrence. The width of a negative surgical margin does not affect survival, recurrence risk, or site of recurrence. A predicted margin of <1 cm after resection of hepatic colorectal metastases should not be used as an exclusion criterion for resection.",
author = "Pawlik, {Timothy M.} and Scoggins, {Charles R.} and Daria Zorzi and Abdalla, {Eddie K.} and Axel Andres and Cathy Eng and Curley, {Steven A.} and Loyer, {Evelyne M.} and Andrea Muratore and Gilles Mentha and Lorenzo Capussotti and Vauthey, {Jean Nicolas} and Choti, {Michael A.} and Adams, {Reid B.} and Bolton, {John S.} and Hemming, {Alan W.} and Cofer, {Joseph B.} and Smythe, {W. Roy} and Clary, {Bryan M.} and Vauthey, {Jean Nicolas}",
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TY - JOUR

T1 - Effect of surgical margin status on survival and site of recurrence after hepatic resection for colorectal metastases

AU - Pawlik, Timothy M.

AU - Scoggins, Charles R.

AU - Zorzi, Daria

AU - Abdalla, Eddie K.

AU - Andres, Axel

AU - Eng, Cathy

AU - Curley, Steven A.

AU - Loyer, Evelyne M.

AU - Muratore, Andrea

AU - Mentha, Gilles

AU - Capussotti, Lorenzo

AU - Vauthey, Jean Nicolas

AU - Choti, Michael A.

AU - Adams, Reid B.

AU - Bolton, John S.

AU - Hemming, Alan W.

AU - Cofer, Joseph B.

AU - Smythe, W. Roy

AU - Clary, Bryan M.

AU - Vauthey, Jean Nicolas

PY - 2005/5

Y1 - 2005/5

N2 - Objective: To evaluate the influence of surgical margin status on survival and site of recurrence in patients treated with hepatic resection for colorectal metastases. Methods: Using a multicenter database, 557 patients who underwent hepatic resection for colorectal metastases were identified. Demographics, operative data, pathologic margin status, site of recurrence (margin, other intrahepatic site, extrahepatic), and long-term survival data were collected and analyzed. Results: On final pathologic analysis, margin status was positive in 45 patients, and negative by 1 to 4 mm in 129, 5 to 9 mm in 85, and ≥1 cm in 298. At a median follow-up of 29 months, the 1-, 3-, and 5-year actuarial survival rates were 97%, 74%, and 58%; median survival was 74 months. Tumor size ≥5 cm, >3 tumor nodules, and carcinoembryonic antigen level >200 ng/mL predicted poor survival (all P < 0.05). Median survival was 49 months in patients with positive margins and not yet reached in patients with negative margins (P = 0.01). After hepatic resection, 225 (40.4%) patients had recurrence: 21 at the surgical margin, 56 at another intrahepatic site, 82 at an extrahepatic site, and 66 at both intrahepatic and extrahepatic sites. Patients with negative margins of 1 to 4 mm, 5 to 9 mm, and ≥1 cm had similar overall recurrence rates (P > 0.05). Patients with positive margins were more likely to have surgical margin recurrence (P = 0.003). Adverse preoperative biologic factors including tumor number greater than 3 (P = 0.01) and a preoperative CEA level greater than 200 ng/mL (P = 0.04) were associated with an increased risk of positive surgical margin. Conclusions: A positive margin after resection of hepatic colorectal metastases is associated with adverse biologic factors and increased risk of surgical-margin recurrence. The width of a negative surgical margin does not affect survival, recurrence risk, or site of recurrence. A predicted margin of <1 cm after resection of hepatic colorectal metastases should not be used as an exclusion criterion for resection.

AB - Objective: To evaluate the influence of surgical margin status on survival and site of recurrence in patients treated with hepatic resection for colorectal metastases. Methods: Using a multicenter database, 557 patients who underwent hepatic resection for colorectal metastases were identified. Demographics, operative data, pathologic margin status, site of recurrence (margin, other intrahepatic site, extrahepatic), and long-term survival data were collected and analyzed. Results: On final pathologic analysis, margin status was positive in 45 patients, and negative by 1 to 4 mm in 129, 5 to 9 mm in 85, and ≥1 cm in 298. At a median follow-up of 29 months, the 1-, 3-, and 5-year actuarial survival rates were 97%, 74%, and 58%; median survival was 74 months. Tumor size ≥5 cm, >3 tumor nodules, and carcinoembryonic antigen level >200 ng/mL predicted poor survival (all P < 0.05). Median survival was 49 months in patients with positive margins and not yet reached in patients with negative margins (P = 0.01). After hepatic resection, 225 (40.4%) patients had recurrence: 21 at the surgical margin, 56 at another intrahepatic site, 82 at an extrahepatic site, and 66 at both intrahepatic and extrahepatic sites. Patients with negative margins of 1 to 4 mm, 5 to 9 mm, and ≥1 cm had similar overall recurrence rates (P > 0.05). Patients with positive margins were more likely to have surgical margin recurrence (P = 0.003). Adverse preoperative biologic factors including tumor number greater than 3 (P = 0.01) and a preoperative CEA level greater than 200 ng/mL (P = 0.04) were associated with an increased risk of positive surgical margin. Conclusions: A positive margin after resection of hepatic colorectal metastases is associated with adverse biologic factors and increased risk of surgical-margin recurrence. The width of a negative surgical margin does not affect survival, recurrence risk, or site of recurrence. A predicted margin of <1 cm after resection of hepatic colorectal metastases should not be used as an exclusion criterion for resection.

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