title: Liver resection for colorectal liver metastases with peri-operative chemotherapy: oncological results of R1 resections.
abstract: BACKGROUND
  Retrospective analysis of outcomes of R0 (negative margin) versus R1 (positive margin) liver resections for colorectal metastases (CLM) in the context of peri-operative chemotherapy.
  
  
  METHODS
  All CLM resections between 2000 and 2006 were reviewed. Exclusion criteria included: macroscopically incomplete (R2) resections, the use of local treatment modalities, the presence of extra-hepatic disease and no peri-operative chemotherapy. R0/R1 status was based on pathological examination.
  
  
  RESULTS
  Of 86 eligible patients, 63 (73%) had R0 and 23 (27%) had R1 resections. The two groups were comparable for the number, size of metastases and type of hepatectomy. The R1 group had more bilobar CLM (52% versus 24%, P = 0.018). The median follow-up was 3.1 years. Five-year overall and disease-free survival were 54% and 21% for the R0 group and 49% and 22% for the R1 group (P = 0.55 and P = 0.39, respectively). An intra-hepatic recurrence was more frequent in the R1 group (52% versus 27%, P = 0.02) and occurred more frequently at the surgical margin (22% versus 3%, P = 0.01).
  
  
  CONCLUSIONS
  R1 resections were associated with a higher risk of intra-hepatic and surgical margin recurrence but did not negatively impact survival suggesting that in the era of efficient chemotherapy, the risk of an R1 resection should not be considered as a contraindication to surgery.
authors: Department of Digestive and Hepatobiliary Surgery, AP-HP, Henri Mondor University Hospital, Créteil, France.
authors: Clarisse
authors: C
authors: Eveno
authors: Mehdi
authors: M
authors: Karoui
authors: Etienne
authors: E
authors: Gayat
authors: Alain
authors: A
authors: Luciani
authors: Marie-Luce
authors: ML
authors: Auriault
authors: Michael D
authors: MD
authors: Kluger
authors: Isabelle
authors: I
authors: Baumgaertner
authors: Laurence
authors: L
authors: Baranes
authors: Alexis
authors: A
authors: Laurent
authors: Claude
authors: C
authors: Tayar
authors: Daniel
authors: D
authors: Azoulay
authors: Daniel
authors: D
authors: Cherqui
mesh_terms: D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D017024:Chemotherapy, Adjuvant; D015179:Colorectal Neoplasms / Q000473:pathology* / Q000628:therapy; D005260:Female; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000556:secondary / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents