Intraoperative Margin Re-Resection for Colorectal Liver Metastases

Wray, Curtis J.; Lowy, Andrew M.; Matthews, Jeffrey B.; James, Laura E.; Mammen, Joshua M.; Choe, Kyuran A.; Hanto, Douglas W.; Ahmad, Syed A.

doi:10.1016/j.jsurg.2007.03.001

« Previous Next »Journal of Surgical Education
Volume 64, Issue 3 , Pages 150-157, May 2007

Intraoperative Margin Re-Resection for Colorectal Liver Metastases

Curtis J. Wray, MD
- Department of Surgery and Radiology, University of Cincinnati Medical Center, Cincinnati, Ohio
Andrew M. Lowy, MD
- Department of Surgery and Radiology, University of Cincinnati Medical Center, Cincinnati, Ohio
Jeffrey B. Matthews, MD
- Department of Surgery and Radiology, University of Cincinnati Medical Center, Cincinnati, Ohio
Laura E. James, MS
- Department of Surgery and Radiology, University of Cincinnati Medical Center, Cincinnati, Ohio
Joshua M. Mammen, MD
- Department of Surgery and Radiology, University of Cincinnati Medical Center, Cincinnati, Ohio
Kyuran A. Choe, MD
- Department of Surgery and Radiology, University of Cincinnati Medical Center, Cincinnati, Ohio
Douglas W. Hanto, MD
- Department of Surgery, Division of Transplantation, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
Syed A. Ahmad, MD
- Department of Surgery and Radiology, University of Cincinnati Medical Center, Cincinnati, Ohio
- Correspondence: Inquiries to Syed A. Ahmad, MD, Division of Surgical Oncology, Department of Surgery, University of Cincinnati College of Medicine, 234 Goodman Street ML 0772, Cincinnati, OH 45219; fax: (513) 584-0459

Objective

Evaluate recurrence and survival in patients who underwent intraoperative margin re-resection for colorectal cancer liver (CRC) metastases.

Design

Retrospective analysis.

Setting

University Hospital, Cincinnati, Ohio. Academic medical center.

Participants

Cohort of 118 patients who underwent resection of CRC liver metastases between 1992 and 2004. All patients were divided into 3 groups: resection margin (MOR) less than 1 cm (n = 64), MOR greater than 1 cm (n = 33), and re-resection margin (re-MOR) greater than 1 cm (n = 21).

Results

Patients with a margin greater than 1 cm, when compared with re-MOR greater than 1 had decreased incidence of liver and distant recurrence (p < 0.05) as well as improved disease-free survival (39.2 vs 22.9 months, p = 0.023). Differences in overall survival (58.6 vs 44.2 months, p = 0.14) were not significant.

Conclusion

Intraoperative re-resection is associated with an increased risk of local and distant recurrence, which may be a reflection of both inadequate surgery and underlying tumor biology.

Key Words: colorectal cancery, hepatic neoplasms, metastasis, hepatectomy

Competency: Medical Knowledge