@article{3123321,
    title = "Impact of Surgical Margin Width on Recurrence and Overall Survival Following R0 Hepatic Resection of Colorectal Metastases: A Systematic Review and Meta-analysis",
    author = "Margonis, G.A. and Sergentanis, T.N. and Ntanasis-Stathopoulos, I. and Andreatos, N. and Tzanninis, I.-G. and Sasaki, K. and Psaltopoulou, T. and Wang, J. and Buettner, S. and Papalois, A.E. and He, J. and Wolfgang, C.L. and Pawlik, T.M. and Weiss, M.J.",
    journal = "Annals of Surgery",
    year = "2018",
    volume = "267",
    number = "6",
    pages = "1047-1055",
    publisher = "Lippincott Williams and Wilkins",
    issn = "0003-4932, 1528-1140",
    doi = "10.1097/SLA.0000000000002552",
    keywords = "Article;  cancer recurrence;  cancer survival;  colorectal liver metastasis;  disease free survival;  human;  liver resection;  meta analysis;  metastasis resection;  overall survival;  priority journal;  procedures;  surgical margin;  systematic review;  colorectal tumor;  liver resection;  liver tumor;  pathology;  procedures;  secondary;  survival analysis, Colorectal Neoplasms;  Disease-Free Survival;  Hepatectomy;  Humans;  Liver Neoplasms;  Margins of Excision;  Survival Analysis",
    abstract = "Objective: To examine the impact of surgical margin width on survival following R0 hepatic resection for colorectal metastases (CRLM). Summary of Background Data: Although negative resection margin is considered of paramount importance for the prognosis of patients with colorectal liver metastases, optimal resection margin width remains controversial. Methods: Eligible studies examining the association between margin status after R0 hepatic resection for CRLM and survival, including overall survival (OS) and disease-free survival (DFS) were sought using the Medline, Cochrane, and EMBASE databases. Random-effects models were used for the calculation of pooled relative risks (RRs) with their 95% confidence intervals (95% CIs). Results: Thirty-four studies were deemed eligible for inclusion representing a cohort of 11,147 hepatic resections. Wider resection margin (>1 vs <1cm) was significantly associated with improved OS at 3 years (pooled RR = 0.86, 95% CI: 0.79-0.95), 5 years (pooled RR = 0.91, 95% CI: 0.85-0.97), and 10 years (pooled RR = 0.94, 95% CI: 0.88-1.00). Similarly, DFS was positively associated with >1cm resection margin at 3, 5, and 10 years. Interestingly, >1mm (vs <1mm) resection margin was significantly associated with improved OS at all-time points. Meta-regression analyses did not reveal any significant modifying role of the study features under investigation, such as the administration of neoadjuvant/adjuvant therapy. Conclusions: Importantly, our findings suggest that while a >1mm margin is associated with better prognosis than a submillimeter margin, achieving a margin >1cm may result in even better oncologic outcomes and should be considered if possible. Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved."
}