Factors affecting surgical margin recurrence after hepatectomy for colorectal liver metastases.
BACKGROUND
Hepatic recurrence after resection of colorectal liver metastasis (CLM) occurs in 50% of patients during follow-up, with 2.8% to 13.9% presenting with surgical margin recurrence (SMR). The aim of this study is to analyze factors that related to SMR in patients with CLM undergoing hepatectomy.


METHODS
Demographics, clinical and survival data of patients who underwent hepatectomy were identified from a prospectively maintained, institutional review board (IRB)-approved database between 2000 and 2012. Statistical analysis was performed using univariate Kaplan Meier and Cox proportional hazard model.


RESULTS
There were 85 female and 121 male patients who underwent liver resection for CLM. An R0 resection was performed in 157 (76%) patients and R1 resection in 49. SMR was detected in 32 patients (15.5%) followed up for a median of 29 months (range, 3-121 months). A half of these patients had undergone R1 (n=16) and another half R0 resection (n=16). Tumor size, preoperative carcinoembryonic antigen (CEA) level and margin status were associated with SMR on univariate analysis. On multivariate analysis, a positive surgical margin was the only independent predictor of SMR. The receipt of adjuvant chemotherapy did not affect margin recurrence. SMR was an independent risk factor associated with worse disease-free (DFS) and overall survival (OS).


CONCLUSIONS
This study shows that SMR, which can be detected in up to 15.5% of patients after liver resection for CLM, adversely affects DFS and OS. The fact that a positive surgical margin was the only predictive factor for SMR in these patients underscores the importance of achieving negative margins during hepatectomy.
Department of General Surgery, Cleveland Clinic, Cleveland, Ohio, USA.
Muhammet
M
Akyuz
Department of General Surgery, Cleveland Clinic, Cleveland, Ohio, USA.
Federico
F
Aucejo
Department of General Surgery, Cleveland Clinic, Cleveland, Ohio, USA.
Cristiano
C
Quintini
Department of General Surgery, Cleveland Clinic, Cleveland, Ohio, USA.
Charles
C
Miller
Department of General Surgery, Cleveland Clinic, Cleveland, Ohio, USA.
John
J
Fung
Department of General Surgery, Cleveland Clinic, Cleveland, Ohio, USA.
Eren
E
Berber
Colorectal liver metastasis (CLM); liver resection; surgical margin recurrence (SMR)