Impact of resection margins for colorectal liver metastases in laparoscopic and open liver resection: a propensity score analysis
Background There is no clear consensus over the optimal width of resection margin for colorectal liver metastases (CRLM), with evolving definitions alongside the advances on the management of the disease. In addition, data on the impact of resection margin after laparoscopic liver resection are stil...
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| Veröffentlicht in: | Surgical endoscopy 2021-02, Vol.35 (2), p.809-818 |
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| creator | Martínez-Cecilia, David Wicherts, Dennis A. Cipriani, Federica Berardi, Giammauro Barkhatov, Leonid Lainas, Panagiotis D’Hondt, Mathieu Rotellar, Fernando Dagher, Ibrahim Aldrighetti, Luca Troisi, Roberto I. Edwin, Bjorn Abu Hilal, Mohammad |
| description | Background
There is no clear consensus over the optimal width of resection margin for colorectal liver metastases (CRLM), with evolving definitions alongside the advances on the management of the disease. In addition, data on the impact of resection margin after laparoscopic liver resection are still scarce.
Methods
Prospectively maintained databases of patients undergoing open or laparoscopic CRLM resection in 7 European tertiary hepatobiliary referral centres were reviewed. After propensity score matching (PSM), the influence of 1 mm and wider margins on OS and DFS were evaluated in open and laparoscopic cohorts.
Results
After PSM, 648 patients were comparable in each group. The incidence of positive margins ( |
| doi_str_mv | 10.1007/s00464-020-07452-4 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2369404932</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2479579248</sourcerecordid><originalsourceid>FETCH-LOGICAL-c375t-46615da7803aabc7d426a57a245f461a17c787b8b6e50fb6428604f884e70c563</originalsourceid><addsrcrecordid>eNp9kU9rFEEQxRsxmE30C3iQBi9eRqv_z3iTYGIg4CWem57entBhZnrsmhX26DdPxd1E8CAUNFT96nXxHmNvBXwUAO4TAmirG5DQgNNGNvoF2witZCOlaF-yDXQKGuk6fcrOEO-B-E6YV-xUSQHOKrVhv6-nJcSVl4HXhCmuucx8CvUuz8iHUnksY6nUDyMf869U-ZTWgFQJeZ75GJZQC8ay5MjDvOVlSfORfBb8zANf6uME87rnRNdEcBj3mPE1OxnCiOnN8T1nPy6_3l58a26-X11ffLlponJmbbS1wmyDa0GF0Ee31dIG44LUZtBWBOGia13f9jYZGHqrZWtBD22rk4NorDpnHw66dMnPXcLVTxljGscwp7JDL5XtNBmkJKHv_0Hvy67SvURp1xnXSd0SJQ9UJAOwpsEvNZN1ey_APwbkDwF5Csj_CchrWnp3lN71U9o-rzwlQoA6AEij-S7Vv3__R_YB8bWcig</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2479579248</pqid></control><display><type>article</type><title>Impact of resection margins for colorectal liver metastases in laparoscopic and open liver resection: a propensity score analysis</title><source>SpringerLink Journals - AutoHoldings</source><creator>Martínez-Cecilia, David ; Wicherts, Dennis A. ; Cipriani, Federica ; Berardi, Giammauro ; Barkhatov, Leonid ; Lainas, Panagiotis ; D’Hondt, Mathieu ; Rotellar, Fernando ; Dagher, Ibrahim ; Aldrighetti, Luca ; Troisi, Roberto I. ; Edwin, Bjorn ; Abu Hilal, Mohammad</creator><creatorcontrib>Martínez-Cecilia, David ; Wicherts, Dennis A. ; Cipriani, Federica ; Berardi, Giammauro ; Barkhatov, Leonid ; Lainas, Panagiotis ; D’Hondt, Mathieu ; Rotellar, Fernando ; Dagher, Ibrahim ; Aldrighetti, Luca ; Troisi, Roberto I. ; Edwin, Bjorn ; Abu Hilal, Mohammad</creatorcontrib><description>Background
There is no clear consensus over the optimal width of resection margin for colorectal liver metastases (CRLM), with evolving definitions alongside the advances on the management of the disease. In addition, data on the impact of resection margin after laparoscopic liver resection are still scarce.
Methods
Prospectively maintained databases of patients undergoing open or laparoscopic CRLM resection in 7 European tertiary hepatobiliary referral centres were reviewed. After propensity score matching (PSM), the influence of 1 mm and wider margins on OS and DFS were evaluated in open and laparoscopic cohorts.
Results
After PSM, 648 patients were comparable in each group. The incidence of positive margins (< 1 mm) was similar in open and laparoscopic groups (17% vs 13%,
p
= 0,142).
Margins < 1 mm were associated with shorter RFS in open (12 vs 26 months,
p
= 0.042) and in laparoscopic group (13 vs 23,
p
= 0,002). Margins < 1 mm were associated with shorter OS in open (36 vs 57 months,
p
= 0.027), but not in laparoscopic group (49 vs 60,
p
= 0,177).
Subgroups with margins ≥ 1 mm (1–4 mm, 5–9 mm, ≥ 10 mm) presented similar RFS in open (p = 0,251) or laparoscopic cohorts (
p
= 0.117), as well as similar OS in open (
p
= 0.295) or laparoscopic cohorts (
p
= 0.908). In the presence of liver recurrence, repeat liver resection was performed in 70 (30%) patients in the open group and 88 (48%) in the laparoscopic group (
p
< 0.001).
Conclusions
Our study suggests that a positive resection margin (less than 1 mm) width does not impact OS after laparoscopic resection of CRLMs as it does in open liver resection. However, a positive margin continues to affect RFS in open and laparoscopic resection. Wider margins than 1 mm do not seem to improve oncological results in open or laparoscopic surgery.</description><identifier>ISSN: 0930-2794</identifier><identifier>EISSN: 1432-2218</identifier><identifier>DOI: 10.1007/s00464-020-07452-4</identifier><identifier>PMID: 32107633</identifier><language>eng</language><publisher>New York: Springer US</publisher><subject>Abdominal Surgery ; Colorectal cancer ; Gastroenterology ; Gynecology ; Hepatectomy ; Hepatology ; Laparoscopy ; Liver ; Medicine ; Medicine & Public Health ; Metastasis ; Proctology ; Surgery</subject><ispartof>Surgical endoscopy, 2021-02, Vol.35 (2), p.809-818</ispartof><rights>Springer Science+Business Media, LLC, part of Springer Nature 2020</rights><rights>Springer Science+Business Media, LLC, part of Springer Nature 2020.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c375t-46615da7803aabc7d426a57a245f461a17c787b8b6e50fb6428604f884e70c563</citedby><cites>FETCH-LOGICAL-c375t-46615da7803aabc7d426a57a245f461a17c787b8b6e50fb6428604f884e70c563</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00464-020-07452-4$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00464-020-07452-4$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,777,781,27905,27906,41469,42538,51300</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32107633$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Martínez-Cecilia, David</creatorcontrib><creatorcontrib>Wicherts, Dennis A.</creatorcontrib><creatorcontrib>Cipriani, Federica</creatorcontrib><creatorcontrib>Berardi, Giammauro</creatorcontrib><creatorcontrib>Barkhatov, Leonid</creatorcontrib><creatorcontrib>Lainas, Panagiotis</creatorcontrib><creatorcontrib>D’Hondt, Mathieu</creatorcontrib><creatorcontrib>Rotellar, Fernando</creatorcontrib><creatorcontrib>Dagher, Ibrahim</creatorcontrib><creatorcontrib>Aldrighetti, Luca</creatorcontrib><creatorcontrib>Troisi, Roberto I.</creatorcontrib><creatorcontrib>Edwin, Bjorn</creatorcontrib><creatorcontrib>Abu Hilal, Mohammad</creatorcontrib><title>Impact of resection margins for colorectal liver metastases in laparoscopic and open liver resection: a propensity score analysis</title><title>Surgical endoscopy</title><addtitle>Surg Endosc</addtitle><addtitle>Surg Endosc</addtitle><description>Background
There is no clear consensus over the optimal width of resection margin for colorectal liver metastases (CRLM), with evolving definitions alongside the advances on the management of the disease. In addition, data on the impact of resection margin after laparoscopic liver resection are still scarce.
Methods
Prospectively maintained databases of patients undergoing open or laparoscopic CRLM resection in 7 European tertiary hepatobiliary referral centres were reviewed. After propensity score matching (PSM), the influence of 1 mm and wider margins on OS and DFS were evaluated in open and laparoscopic cohorts.
Results
After PSM, 648 patients were comparable in each group. The incidence of positive margins (< 1 mm) was similar in open and laparoscopic groups (17% vs 13%,
p
= 0,142).
Margins < 1 mm were associated with shorter RFS in open (12 vs 26 months,
p
= 0.042) and in laparoscopic group (13 vs 23,
p
= 0,002). Margins < 1 mm were associated with shorter OS in open (36 vs 57 months,
p
= 0.027), but not in laparoscopic group (49 vs 60,
p
= 0,177).
Subgroups with margins ≥ 1 mm (1–4 mm, 5–9 mm, ≥ 10 mm) presented similar RFS in open (p = 0,251) or laparoscopic cohorts (
p
= 0.117), as well as similar OS in open (
p
= 0.295) or laparoscopic cohorts (
p
= 0.908). In the presence of liver recurrence, repeat liver resection was performed in 70 (30%) patients in the open group and 88 (48%) in the laparoscopic group (
p
< 0.001).
Conclusions
Our study suggests that a positive resection margin (less than 1 mm) width does not impact OS after laparoscopic resection of CRLMs as it does in open liver resection. However, a positive margin continues to affect RFS in open and laparoscopic resection. Wider margins than 1 mm do not seem to improve oncological results in open or laparoscopic surgery.</description><subject>Abdominal Surgery</subject><subject>Colorectal cancer</subject><subject>Gastroenterology</subject><subject>Gynecology</subject><subject>Hepatectomy</subject><subject>Hepatology</subject><subject>Laparoscopy</subject><subject>Liver</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Metastasis</subject><subject>Proctology</subject><subject>Surgery</subject><issn>0930-2794</issn><issn>1432-2218</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNp9kU9rFEEQxRsxmE30C3iQBi9eRqv_z3iTYGIg4CWem57entBhZnrsmhX26DdPxd1E8CAUNFT96nXxHmNvBXwUAO4TAmirG5DQgNNGNvoF2witZCOlaF-yDXQKGuk6fcrOEO-B-E6YV-xUSQHOKrVhv6-nJcSVl4HXhCmuucx8CvUuz8iHUnksY6nUDyMf869U-ZTWgFQJeZ75GJZQC8ay5MjDvOVlSfORfBb8zANf6uME87rnRNdEcBj3mPE1OxnCiOnN8T1nPy6_3l58a26-X11ffLlponJmbbS1wmyDa0GF0Ee31dIG44LUZtBWBOGia13f9jYZGHqrZWtBD22rk4NorDpnHw66dMnPXcLVTxljGscwp7JDL5XtNBmkJKHv_0Hvy67SvURp1xnXSd0SJQ9UJAOwpsEvNZN1ey_APwbkDwF5Csj_CchrWnp3lN71U9o-rzwlQoA6AEij-S7Vv3__R_YB8bWcig</recordid><startdate>20210201</startdate><enddate>20210201</enddate><creator>Martínez-Cecilia, David</creator><creator>Wicherts, Dennis A.</creator><creator>Cipriani, Federica</creator><creator>Berardi, Giammauro</creator><creator>Barkhatov, Leonid</creator><creator>Lainas, Panagiotis</creator><creator>D’Hondt, Mathieu</creator><creator>Rotellar, Fernando</creator><creator>Dagher, Ibrahim</creator><creator>Aldrighetti, Luca</creator><creator>Troisi, Roberto I.</creator><creator>Edwin, Bjorn</creator><creator>Abu Hilal, Mohammad</creator><general>Springer US</general><general>Springer Nature B.V</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope></search><sort><creationdate>20210201</creationdate><title>Impact of resection margins for colorectal liver metastases in laparoscopic and open liver resection: a propensity score analysis</title><author>Martínez-Cecilia, David ; Wicherts, Dennis A. ; Cipriani, Federica ; Berardi, Giammauro ; Barkhatov, Leonid ; Lainas, Panagiotis ; D’Hondt, Mathieu ; Rotellar, Fernando ; Dagher, Ibrahim ; Aldrighetti, Luca ; Troisi, Roberto I. ; Edwin, Bjorn ; Abu Hilal, Mohammad</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c375t-46615da7803aabc7d426a57a245f461a17c787b8b6e50fb6428604f884e70c563</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Abdominal Surgery</topic><topic>Colorectal cancer</topic><topic>Gastroenterology</topic><topic>Gynecology</topic><topic>Hepatectomy</topic><topic>Hepatology</topic><topic>Laparoscopy</topic><topic>Liver</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Metastasis</topic><topic>Proctology</topic><topic>Surgery</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Martínez-Cecilia, David</creatorcontrib><creatorcontrib>Wicherts, Dennis A.</creatorcontrib><creatorcontrib>Cipriani, Federica</creatorcontrib><creatorcontrib>Berardi, Giammauro</creatorcontrib><creatorcontrib>Barkhatov, Leonid</creatorcontrib><creatorcontrib>Lainas, Panagiotis</creatorcontrib><creatorcontrib>D’Hondt, Mathieu</creatorcontrib><creatorcontrib>Rotellar, Fernando</creatorcontrib><creatorcontrib>Dagher, Ibrahim</creatorcontrib><creatorcontrib>Aldrighetti, Luca</creatorcontrib><creatorcontrib>Troisi, Roberto I.</creatorcontrib><creatorcontrib>Edwin, Bjorn</creatorcontrib><creatorcontrib>Abu Hilal, Mohammad</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>Surgical endoscopy</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Martínez-Cecilia, David</au><au>Wicherts, Dennis A.</au><au>Cipriani, Federica</au><au>Berardi, Giammauro</au><au>Barkhatov, Leonid</au><au>Lainas, Panagiotis</au><au>D’Hondt, Mathieu</au><au>Rotellar, Fernando</au><au>Dagher, Ibrahim</au><au>Aldrighetti, Luca</au><au>Troisi, Roberto I.</au><au>Edwin, Bjorn</au><au>Abu Hilal, Mohammad</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Impact of resection margins for colorectal liver metastases in laparoscopic and open liver resection: a propensity score analysis</atitle><jtitle>Surgical endoscopy</jtitle><stitle>Surg Endosc</stitle><addtitle>Surg Endosc</addtitle><date>2021-02-01</date><risdate>2021</risdate><volume>35</volume><issue>2</issue><spage>809</spage><epage>818</epage><pages>809-818</pages><issn>0930-2794</issn><eissn>1432-2218</eissn><abstract>Background
There is no clear consensus over the optimal width of resection margin for colorectal liver metastases (CRLM), with evolving definitions alongside the advances on the management of the disease. In addition, data on the impact of resection margin after laparoscopic liver resection are still scarce.
Methods
Prospectively maintained databases of patients undergoing open or laparoscopic CRLM resection in 7 European tertiary hepatobiliary referral centres were reviewed. After propensity score matching (PSM), the influence of 1 mm and wider margins on OS and DFS were evaluated in open and laparoscopic cohorts.
Results
After PSM, 648 patients were comparable in each group. The incidence of positive margins (< 1 mm) was similar in open and laparoscopic groups (17% vs 13%,
p
= 0,142).
Margins < 1 mm were associated with shorter RFS in open (12 vs 26 months,
p
= 0.042) and in laparoscopic group (13 vs 23,
p
= 0,002). Margins < 1 mm were associated with shorter OS in open (36 vs 57 months,
p
= 0.027), but not in laparoscopic group (49 vs 60,
p
= 0,177).
Subgroups with margins ≥ 1 mm (1–4 mm, 5–9 mm, ≥ 10 mm) presented similar RFS in open (p = 0,251) or laparoscopic cohorts (
p
= 0.117), as well as similar OS in open (
p
= 0.295) or laparoscopic cohorts (
p
= 0.908). In the presence of liver recurrence, repeat liver resection was performed in 70 (30%) patients in the open group and 88 (48%) in the laparoscopic group (
p
< 0.001).
Conclusions
Our study suggests that a positive resection margin (less than 1 mm) width does not impact OS after laparoscopic resection of CRLMs as it does in open liver resection. However, a positive margin continues to affect RFS in open and laparoscopic resection. Wider margins than 1 mm do not seem to improve oncological results in open or laparoscopic surgery.</abstract><cop>New York</cop><pub>Springer US</pub><pmid>32107633</pmid><doi>10.1007/s00464-020-07452-4</doi><tpages>10</tpages></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0930-2794 |
| ispartof | Surgical endoscopy, 2021-02, Vol.35 (2), p.809-818 |
| issn | 0930-2794 1432-2218 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_2369404932 |
| source | SpringerLink Journals - AutoHoldings |
| subjects | Abdominal Surgery Colorectal cancer Gastroenterology Gynecology Hepatectomy Hepatology Laparoscopy Liver Medicine Medicine & Public Health Metastasis Proctology Surgery |
| title | Impact of resection margins for colorectal liver metastases in laparoscopic and open liver resection: a propensity score analysis |
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