Τίτλος:
Impact of Surgical Margin Width on Recurrence and Overall Survival Following R0 Hepatic Resection of Colorectal Metastases: A Systematic Review and Meta-analysis
Γλώσσες Τεκμηρίου:
Αγγλικά
Περίληψη:
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.
Συγγραφείς:
Margonis, G.A.
Sergentanis, T.N.
Ntanasis-Stathopoulos, I.
Andreatos, N.
Tzanninis, I.-G.
Sasaki, K.
Psaltopoulou, T.
Wang, J.
Buettner, S.
Papalois, A.E.
He, J.
Wolfgang, C.L.
Pawlik, T.M.
Weiss, M.J.
Περιοδικό:
Annals of Surgery
Εκδότης:
Lippincott Williams and Wilkins
Λέξεις-κλειδιά:
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
DOI:
10.1097/SLA.0000000000002552
