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Importance of resection margin after resection of colorectal liver metastases in the era of modern chemotherapy : population-based cohort study

Östrand, Emil LU ; Rystedt, Jenny LU ; Engstrand, Jennie ; Frühling, Petter ; Hemmingsson, Oskar ; Sandström, Per ; Sternby Eilard, Malin ; Tingstedt, Bobby LU and Buchwald, Pamela LU (2024) In BJS Open 8(3).
Abstract

Background: Resection margin has been associated with overall survival following liver resection for colorectal liver metastasis. The aim of this study was to examine how resection margins of 0.0 mm, 0.1-0.9 mm and =1 mm influence overall survival in patients resected for colorectal liver metastasis in a time of modern perioperative chemotherapy and surgery. Methods: Using data from the national registries Swedish Colorectal Cancer Registry and Swedish National Quality Registry for Liver, Bile Duct and Gallbladder Cancer, patients that had liver resections for colorectal liver metastasis between 2009 and 2013 were included. In patients with a narrow or unknown surgical margin the original pathological reports were re-reviewed. Factors... (More)

Background: Resection margin has been associated with overall survival following liver resection for colorectal liver metastasis. The aim of this study was to examine how resection margins of 0.0 mm, 0.1-0.9 mm and =1 mm influence overall survival in patients resected for colorectal liver metastasis in a time of modern perioperative chemotherapy and surgery. Methods: Using data from the national registries Swedish Colorectal Cancer Registry and Swedish National Quality Registry for Liver, Bile Duct and Gallbladder Cancer, patients that had liver resections for colorectal liver metastasis between 2009 and 2013 were included. In patients with a narrow or unknown surgical margin the original pathological reports were re-reviewed. Factors influencing overall survival were analysed using a Cox proportional hazard model. Results: A total of 754 patients had a known margin status, of which 133 (17.6%) patients had a resection margin <1 mm. The overall survival in patients with a margin of 0 mm or 0.1-0.9 mm was 42 (95% c.i. 31 to 53) and 48 (95% c.i. 35 to 62) months respectively, compared with 75 (95% c.i. 65 to 85) for patients with =1 mm margin, P < 0.001. Margins of 0 mm or 0.1-0.9 mm were associated with poor overall survival in the multivariable analysis, HR 1.413 (95% c.i. 1.030 to 1.939), P = 0.032, and 1.399 (95% c.i. 1.025 to 1.910), P = 0.034, respectively. Conclusions: Despite modern chemotherapy the resection margin is still an important factor for the survival of patients resected for colorectal liver metastasis, and a margin of =1 mm is needed to achieve the best possible outcome.

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type
Contribution to journal
publication status
published
subject
in
BJS Open
volume
8
issue
3
article number
zrae035
publisher
Wiley
external identifiers
  • scopus:85192594668
  • pmid:38717909
ISSN
2474-9842
DOI
10.1093/bjsopen/zrae035
language
English
LU publication?
yes
id
e18aa592-10f8-4709-9f8f-ba15491d25b8
date added to LUP
2024-05-28 14:13:06
date last changed
2024-06-11 15:08:04
@article{e18aa592-10f8-4709-9f8f-ba15491d25b8,
  abstract     = {{<p>Background: Resection margin has been associated with overall survival following liver resection for colorectal liver metastasis. The aim of this study was to examine how resection margins of 0.0 mm, 0.1-0.9 mm and =1 mm influence overall survival in patients resected for colorectal liver metastasis in a time of modern perioperative chemotherapy and surgery. Methods: Using data from the national registries Swedish Colorectal Cancer Registry and Swedish National Quality Registry for Liver, Bile Duct and Gallbladder Cancer, patients that had liver resections for colorectal liver metastasis between 2009 and 2013 were included. In patients with a narrow or unknown surgical margin the original pathological reports were re-reviewed. Factors influencing overall survival were analysed using a Cox proportional hazard model. Results: A total of 754 patients had a known margin status, of which 133 (17.6%) patients had a resection margin &lt;1 mm. The overall survival in patients with a margin of 0 mm or 0.1-0.9 mm was 42 (95% c.i. 31 to 53) and 48 (95% c.i. 35 to 62) months respectively, compared with 75 (95% c.i. 65 to 85) for patients with =1 mm margin, P &lt; 0.001. Margins of 0 mm or 0.1-0.9 mm were associated with poor overall survival in the multivariable analysis, HR 1.413 (95% c.i. 1.030 to 1.939), P = 0.032, and 1.399 (95% c.i. 1.025 to 1.910), P = 0.034, respectively. Conclusions: Despite modern chemotherapy the resection margin is still an important factor for the survival of patients resected for colorectal liver metastasis, and a margin of =1 mm is needed to achieve the best possible outcome.</p>}},
  author       = {{Östrand, Emil and Rystedt, Jenny and Engstrand, Jennie and Frühling, Petter and Hemmingsson, Oskar and Sandström, Per and Sternby Eilard, Malin and Tingstedt, Bobby and Buchwald, Pamela}},
  issn         = {{2474-9842}},
  language     = {{eng}},
  number       = {{3}},
  publisher    = {{Wiley}},
  series       = {{BJS Open}},
  title        = {{Importance of resection margin after resection of colorectal liver metastases in the era of modern chemotherapy : population-based cohort study}},
  url          = {{http://dx.doi.org/10.1093/bjsopen/zrae035}},
  doi          = {{10.1093/bjsopen/zrae035}},
  volume       = {{8}},
  year         = {{2024}},
}