title: Surgical margin in hepatic resection for colorectal metastasis: a critical and improvable determinant of outcome.
abstract: OBJECTIVE
  To update the analysis of technical and biologic factors related to hepatic resection for colorectal metastasis in a large single-institution series to identify important prognostic indicators and patterns of failure.
  
  
  BACKGROUND
  Surgical therapy for colorectal carcinoma metastatic to the liver is the only potentially curable treatment. Careful patient selection of those with resectable liver-only metastatic disease is crucial to the success of surgical therapy.
  
  
  METHODS
  Two hundred forty-four consecutive patients undergoing curative hepatic resection for metastatic colorectal carcinoma were analyzed retrospectively. Variables examined included sex, stage of primary lesion, size of liver lesion(s), number of lesions, disease-free interval, ploidy, differentiation, preoperative carcinoembryonic antigen level, and operative factors such as resection margin, use of cryotherapy, intraoperative ultrasound, and blood loss.
  
  
  RESULTS
  Surgical margin, number of lesions, and carcinoembryonic antigen (CEA) levels significantly control prognosis. Patients with only one or two liver lesions, a 1-cm surgical margin, and low CEA levels have a 5-year disease-free survival rate of more than 30%. Disease-free interval, original stage, bilobar involvement, size of metastasis, differentiation, and ploidy were not significant predictors of recurrence. The pattern of failure correlates with surgical margin. Routine use of intraoperative ultrasound resulted in an increased incidence of negative surgical margin during the period examined.
  
  
  CONCLUSIONS
  Surgical resection or cryotherapy of hepatic metastasis from colorectal cancer is safe and curable in appropriately selected patients. Biologic factors, such as number of lesions and carcinoembryonic antigen levels, determine potential curability, and surgical margin governs the patterns of failure and outcome in potentially curable patients. Optimization of selection criteria and surgical resection margins will improve outcome.
authors.affiliation: Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: B
authors.initials: B
authors.lastname: Cady
authors.forename: R L
authors.initials: RL
authors.lastname: Jenkins
authors.forename: G D
authors.initials: GD
authors.lastname: Steele
authors.forename: W D
authors.initials: WD
authors.lastname: Lewis
authors.forename: M D
authors.initials: MD
authors.lastname: Stone
authors.forename: W V
authors.initials: WV
authors.lastname: McDermott
authors.forename: J M
authors.initials: JM
authors.lastname: Jessup
authors.forename: A
authors.initials: A
authors.lastname: Bothe
authors.forename: P
authors.initials: P
authors.lastname: Lalor
authors.forename: E J
authors.initials: EJ
authors.lastname: Lovett
authors.forename: P
authors.initials: P
authors.lastname: Lavin
authors.forename: D C
authors.initials: DC
authors.lastname: Linehan
mesh_terms: D002272:Carcinoembryonic Antigen / Q000097:blood; D015179:Colorectal Neoplasms / Q000473:pathology* / Q000601:surgery; D003452:Cryosurgery; D018572:Disease-Free Survival; D005500:Follow-Up Studies; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000097:blood / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D009017:Morbidity; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies
chemical_list: D002272:Carcinoembryonic Antigen