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Impact of surgical margins on overall and recurrence-free survival in parenchymal-sparing laparoscopic liver resections of colorectal metastases

Roberto Montalti (UGent) , Federico Tomassini (UGent) , Stéphanie Laurent (UGent) , Peter Smeets (UGent) , Marc De Man (UGent) , Karen Geboes (UGent) , Louis Libbrecht (UGent) and Roberto Troisi (UGent)
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Abstract
The relationship between the width of surgical margins and local and distant recurrence of colorectal liver metastases (CRLM) remain controversial. We analyzed the impact of surgical margins in laparoscopic liver resections (LLR) for CRLM, using the parenchymal-sparing approach on overall (OS) and recurrence-free survival (RFS). From January 2005 to October 2012, 114 first LLR for CRLM were performed and retrospectively analyzed. The ultrasonic aspirator was used for parenchyma division. R1 margins were defined when the tissue width was < 1 mm. After a mean follow-up of 30.9 +/- A 1.71 months, OS was 97.1-73.9-58.9 % and the RFS 64.2-35.2-31 % at 1-3-5 years, respectively. The major resection rate was 7 %. The median margin width was 3 (0-40) mm, and R1 resection was recorded in 14 (12.3 %) cases. Twenty-two patients (33.3 %) with hepatic recurrence underwent a repeat hepatectomy. R1 margins were significantly related to lower RFS survival (p = 0.038) but did not affect OS. Multivariate analysis showed that lesions located in postero-superior segments (HR = 2.4, 95 % CI 1.24-4.61, p = 0.009) as well as blood loss (HR = 3.2, 95 % CI 1.23-7.99, p = 0.012) were independent risk factors for tumor recurrence. The carcinoembryonic antigen level > 10 mcg/L affected OS (HR = 4.2 95 % CI 2.02-16.9, p = 0.001), and the resection of more than two tumors was significantly associated with R1 margins (HR = 9.32, 95 % CI 1.14-32.5, p = 0.037). Laparoscopic parenchymal-sparing surgery of CRLM does not compromise the oncological outcome, allowing a higher percentage of repeat hepatectomy. R1 margins are a risk factor for tumor recurrence but not for overall survival. The presence of multiple lesions is the only independent risk factor of R1 margins and also the major disadvantage of this technique.
Keywords
Laparoscopic liver resection, Surgical margins, R1 margins, Colorectal liver metastases, Surgery, Parenchymal-sparing approach, HEPATIC RESECTION, NEOADJUVANT CHEMOTHERAPY, CANCER, SURGERY, CARCINOMA, DETERMINANT, OUTCOMES, SIZE, ERA, R1

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Chicago
Montalti, Roberto, Federico Tomassini, Stéphanie Laurent, Peter Smeets, Marc De Man, Karen Geboes, Louis Libbrecht, and Roberto Troisi. 2015. “Impact of Surgical Margins on Overall and Recurrence-free Survival in Parenchymal-sparing Laparoscopic Liver Resections of Colorectal Metastases.” Surgical Endoscopy and Other Interventional Techniques 29 (9): 2736–2747.
APA
Montalti, R., Tomassini, F., Laurent, S., Smeets, P., De Man, M., Geboes, K., Libbrecht, L., et al. (2015). Impact of surgical margins on overall and recurrence-free survival in parenchymal-sparing laparoscopic liver resections of colorectal metastases. SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES, 29(9), 2736–2747.
Vancouver
1.
Montalti R, Tomassini F, Laurent S, Smeets P, De Man M, Geboes K, et al. Impact of surgical margins on overall and recurrence-free survival in parenchymal-sparing laparoscopic liver resections of colorectal metastases. SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES. 2015;29(9):2736–47.
MLA
Montalti, Roberto, Federico Tomassini, Stéphanie Laurent, et al. “Impact of Surgical Margins on Overall and Recurrence-free Survival in Parenchymal-sparing Laparoscopic Liver Resections of Colorectal Metastases.” SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES 29.9 (2015): 2736–2747. Print.
@article{8514887,
  abstract     = {The relationship between the width of surgical margins and local and distant recurrence of colorectal liver metastases (CRLM) remain controversial. We analyzed the impact of surgical margins in laparoscopic liver resections (LLR) for CRLM, using the parenchymal-sparing approach on overall (OS) and recurrence-free survival (RFS). 
From January 2005 to October 2012, 114 first LLR for CRLM were performed and retrospectively analyzed. The ultrasonic aspirator was used for parenchyma division. R1 margins were defined when the tissue width was {\textlangle} 1 mm. 
After a mean follow-up of 30.9 +/- A 1.71 months, OS was 97.1-73.9-58.9 \% and the RFS 64.2-35.2-31 \% at 1-3-5 years, respectively. The major resection rate was 7 \%. The median margin width was 3 (0-40) mm, and R1 resection was recorded in 14 (12.3 \%) cases. Twenty-two patients (33.3 \%) with hepatic recurrence underwent a repeat hepatectomy. R1 margins were significantly related to lower RFS survival (p = 0.038) but did not affect OS. Multivariate analysis showed that lesions located in postero-superior segments (HR = 2.4, 95 \% CI 1.24-4.61, p = 0.009) as well as blood loss (HR = 3.2, 95 \% CI 1.23-7.99, p = 0.012) were independent risk factors for tumor recurrence. The carcinoembryonic antigen level {\textrangle} 10 mcg/L affected OS (HR = 4.2 95 \% CI 2.02-16.9, p = 0.001), and the resection of more than two tumors was significantly associated with R1 margins (HR = 9.32, 95 \% CI 1.14-32.5, p = 0.037). 
Laparoscopic parenchymal-sparing surgery of CRLM does not compromise the oncological outcome, allowing a higher percentage of repeat hepatectomy. R1 margins are a risk factor for tumor recurrence but not for overall survival. The presence of multiple lesions is the only independent risk factor of R1 margins and also the major disadvantage of this technique.},
  author       = {Montalti, Roberto and Tomassini, Federico and Laurent, St{\'e}phanie and Smeets, Peter and De Man, Marc and Geboes, Karen and Libbrecht, Louis and Troisi, Roberto},
  issn         = {0930-2794},
  journal      = {SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES},
  keyword      = {Laparoscopic liver resection,Surgical margins,R1 margins,Colorectal liver metastases,Surgery,Parenchymal-sparing approach,HEPATIC RESECTION,NEOADJUVANT CHEMOTHERAPY,CANCER,SURGERY,CARCINOMA,DETERMINANT,OUTCOMES,SIZE,ERA,R1},
  language     = {eng},
  number       = {9},
  pages        = {2736--2747},
  title        = {Impact of surgical margins on overall and recurrence-free survival in parenchymal-sparing laparoscopic liver resections of colorectal metastases},
  url          = {http://dx.doi.org/10.1007/s00464-014-3999-3},
  volume       = {29},
  year         = {2015},
}

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