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

IF 3.5 3区 医学 Q1 SURGERY
BJS Open Pub Date : 2024-05-08 DOI:10.1093/bjsopen/zrae035
Emil Östrand, Jenny Rystedt, Jennie Engstrand, Petter Frühling, Oskar Hemmingsson, Per Sandström, Malin Sternby Eilard, Bobby Tingstedt, Pamela Buchwald
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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 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.

现代化疗时代结直肠肝转移灶切除术后切除边缘的重要性:基于人群的队列研究。
背景:切除边缘与结直肠肝转移肝切除术后的总生存率有关。本研究旨在探讨在现代围手术期化疗和手术时代,0.0 毫米、0.1-0.9 毫米和≥1 毫米的切除边缘如何影响结直肠肝转移患者的总生存率:利用瑞典结直肠癌登记处和瑞典国家肝癌、胆管癌和胆囊癌质量登记处的数据,纳入了2009年至2013年期间因结直肠肝转移而接受肝切除术的患者。对于手术切缘狭窄或未知的患者,将重新审查原始病理报告。采用考克斯比例危险模型分析了影响总生存率的因素:结果:共有 754 例患者有已知的边缘状态,其中 133 例(17.6%)患者有切除边缘:尽管采用了现代化疗方法,但切除边缘仍然是结直肠肝转移患者生存的重要因素,边缘≥1毫米才能达到最佳效果。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
BJS Open
BJS Open SURGERY-
CiteScore
6.00
自引率
3.20%
发文量
144
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