48 - Preissitzung
Felix Largiadèr Preissitzung
16. Mai 2019, 10:15 - 11:45, Bellavista 3+4, 6. OG
Survival after hepatectomy for colorectal liver metastases is a function of intrahepatic recurrence but is not dependent of recurrence at the liver resection margin
A. Andreou, D. Kradolfer, A. Andreou, M. Maurer, S. Knitter, A. Lachenmayer, V. Banz, D. Candinas, G. Beldi, Presenter: D. Kradolfer (Bern)
Resection margin status is associated with oncologic outcomes following liver resection for colorectal liver metastases (CLM). Previous studies however, did not differentiate between true local recurrence at the resection margin versus recurrence elsewhere in the liver. This study aims to determine if resection margin represents only a surrogate of advanced disease while not causally determining overall survival (OS).
Clinicopathological data of patients who underwent curative hepatic resection for CLM between 2012 and 2017 at a major hepatobiliary center in Switzerland were assessed. Follow-up cross-sectional imaging following hepatectomy was reviewed by an independent radiologist to identify the presence and location of recurrent disease. Location of intrahepatic recurrence was distinguished in true local recurrence (only at the resection margin) versus intrahepatic recurrence elsewhere. The association between surgical margin status and location and frequency of tumor recurrence was evaluated and the impact of true local recurrence on OS was analyzed.
During the study period, 91 patients underwent liver resection for CLM with curative intent. Surgical margins were positive for tumor cells (R1) in 10 patients (11%). After a median follow-up time of 47 months, tumor recurrence was identified in 54 patients (59%). Location of recurrence disease was independent from the R1 status (p = 0.063). True local recurrence was not associated with worse OS among patients with recurrent disease (true local recurrence vs. elsewhere: 3-year OS: 73% vs. 65%, p = 0.729). Main determinants of survival were no recurrence, any intrahepatic recurrence, and extrahepatic recurrence (p = 0.012).
R1 margin status was not associated with more frequent true local recurrence compared to other locations of recurrent disease. Additionally, the impact of true local recurrence on OS was not significantly different from that of any intrahepatic recurrent disease. Thus, based on our findings, R1 status should be considered as a surrogate parameter of extensive disease and potentially aggressive tumor biology. It should be used as an indicator for the need of intensive systemic treatment and close postoperative surveillance.