HPB3 - Role of Intraoperative Margin Treatment for Resection of Colorectal Liver Metastases
Saturday, February 15, 2020
8:00 AM – 8:15 AM
Location: Sebastian I 1/2
Introduction: This study examines the effect of intraoperative margin treatment on recurrence and survival in colorectal cancer patients with liver metastases who receive curative-intent hepatectomy. Methods: A retrospective review of a prospective hepatobiliary database was performed of 335 patients receiving hepatectomy for metastatic colorectal carcinoma from November 1996 to June 2017. Surgical margin treatment was defined as either re-resection or ablation of resection margin. Patients were stratified into three groups: R0 resection, R1 resection without margin treatment, and R1 resection with margin treatment. Results: Analysis included 335 patients undergoing 368 procedures. 286 (85.37%) patients underwent R0 resection, 28 (8.36%) patients underwent R1 resection without margin treatment, and 21 (6.27%) patients underwent R1 resection with margin treatment. Rates of local hepatic recurrence (p=0.15), new hepatic recurrence (p=0.70), and extra-hepatic recurrence (p=0.24) did not differ between the three groups. Median OS for all three groups was 44.2 months, 26.0 months, and 20.3 months for the R0 group, R1 without margin treatment group, and the R1 with margin treatment respectively (p=0.0008). On multivariate analysis, the margin group (p=0.045), gender (p=0.033), and ablation (p<0.0001) were all significantly associated with OS. Conclusion: Intraoperative margin treatment for positive margin during resection of colorectal liver metastases did not have any effect on recurrence. R1 resection is associated with decreased OS compared to R0 resection, regardless of margin treatment. It is unclear if this is due to poor tumor biology associated with a positive resection margin or inadequate margin treatment.