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The Significance and Clinical Factors Associated With a Subcentimeter Resection of Colorectal Liver Metastases

¹ Department of Surgery, Division of Surgical Oncology, University of Cincinnati Medical Center, 234 Goodman Street, ML 0772, Cincinnati, Ohio 45219
² Department of Radiology, University of Cincinnati Medical Center, 231 Albert Sabin Way, Cincinnati, Ohio 45267
³ Department of Surgery, Division of Transplantation, Beth Israel Deaconess Medical Center, Harvard Medical School, 110 Francis Street, 7th Floor, Boston, Massachusetts 02215

Correspondence: Address correspondence and reprint requests to: S.A. Ahmad, MD; E-mail: ahmadsy{at}uc.edu.

Background: Prognosis after resection of colorectal liver metastases is influenced by various factors. A positive margin of resection (MOR) has been shown to adversely influence prognosis. Although a 1-cm MOR has been accepted as adequate, the data to support this guideline are sparse.

Methods: Our hepatobiliary database was queried for patients who underwent liver resection for colorectal metastases between January 1992 and July 2003. All patients were divided into three groups: MOR <.5 cm (group A), .5 to 1 cm (group B), and >1 cm (group C). Operative reports from each hepatic resection were analyzed to determine local factors that may have contributed to a subcentimeter MOR.

Results: A total of 112 patients (67 men and 45 women) underwent liver resection for colorectal metastases with negative margins. Fifty-three patients were in group A, 26 patients were in group B, and 33 patients were in group C. Group C demonstrated decreased local recurrence (LR; P = .003), distant recurrence (DR; P = .008), and disease-free recurrence (P = .002). A significant difference in the overall time to LR (P = .003), time to DR (P = .003), and disease-free survival (P = .002) was also demonstrated. Factors associated with a subcentimeter MOR included nonanatomical resection (P = .043), proximity to a major vessel (P = .003), and central location (P = .002).

Conclusions: A <1-cm resection for colorectal liver metastases is associated with increased LR and DR, as well as decreased disease-free survival. When a nonanatomical resection is performed, a MOR >1 cm should be attempted, because an adequate margin is often underestimated. Considerations should be made for extended resections when tumors are centrally located or near major vessels.

Key Words: Colon cancer • Hepatic metastases • Resection margin • Liver surgery

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