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 > or =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 > or =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 > or =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.
authors.affiliation: Department of Surgical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030, USA.
authors.forename: Timothy M
authors.initials: TM
authors.lastname: Pawlik
authors.forename: Charles R
authors.initials: CR
authors.lastname: Scoggins
authors.forename: Daria
authors.initials: D
authors.lastname: Zorzi
authors.forename: Eddie K
authors.initials: EK
authors.lastname: Abdalla
authors.forename: Axel
authors.initials: A
authors.lastname: Andres
authors.forename: Cathy
authors.initials: C
authors.lastname: Eng
authors.forename: Steven A
authors.initials: SA
authors.lastname: Curley
authors.forename: Evelyne M
authors.initials: EM
authors.lastname: Loyer
authors.forename: Andrea
authors.initials: A
authors.lastname: Muratore
authors.forename: Gilles
authors.initials: G
authors.lastname: Mentha
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Capussotti
authors.forename: Jean-Nicolas
authors.initials: JN
authors.lastname: Vauthey
mesh_terms: D015179:Colorectal Neoplasms / Q000473:pathology*; D005260:Female; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology*; D011379:Prognosis; D016019:Survival Analysis