Margin Status is Still an Important Prognostic Factor in Hepatectomies for Colorectal Liver Metastases: A Propensity Score Matching Analysis
Authors: Memeo Riccardo , de Blasi Vito , Adam Rene , Goéré Diane , Piardi Tullio , Lermite Emilie , Turrini Olivier , Navarro Francis , de’Angelis Nicola , Cunha Antonio Sa , Pessaux Patrick ,   French Colorectal Liver Metastases Working Group, Association Française de Chirurgie (AFC), Cosse Cyril , Lignier Delphine , Regimbeau Jean Marc , Barbieux Julien , Lermite Emilie , Hamy Antoine , Mauvais François , Laurent Christophe , Naasan Irchid Al , Laurent Alexis , Azoulay Daniel , Compagnon Philippe , de’Angelis Nicola , Idrissi Mohammed Sbai , Martin Fréderic , Atger Jerôme , Baulieux Jacques , Darnis Benjamin , Yves Jean , Mabrut  , Kepenekian Vahan , Perinel Julie , Adham Mustapha , Glehen Olivier , Rivoire Michel , Hardwigsen Jean , Palen Anais , Grégoire Emilie , LeTreut Yves Patrice , Delpero Jean Robert , Turrini Olivier , Herrero Astrid , Navarro Francis , Panaro Fabrizio , Ayav Ahmet , Bresler Laurent , Rauch Philippe , Guillemin François , Marchal Fréderic , Gugenheim Jean , Iannelli Antonio , Benoist Stephane , Brouquet Antoine , Pocard Marc , Dico Réa Lo , Gayet Brice , Fuks David , Scatton Olivier. , Soubrane Olivier , Vaillant Jean‐Christophe , Piardi Tullio , Sommacale Daniel , Kianmanesh Reza , Comy Michel , Bachellier Philippe , Oussoultzoglou Elie , Addeo Pietro , Ntourakis Dimitrios , Pessaux Patrick , Mutter Didier , Marescaux Jacques , Raoux Loïc , Suc Bertrand , Muscari Fabrice , ELHOMSY Georges , Gelli Maximiliano , Cunha Antonio Sa , Adam René , Castaing Denis , Cherqui Daniel , Pittau Gabriella , Ciacio Oriana , Vibert Eric , Elias Dominique , Goére Diane , Vittadello Fabrizio 
Published: September 2017

Objective

The width of resection margin is still a matter of debate in case of colorectal liver metastasis resection. The aim of this study was to determine the risk factors for R1 resection. Once risk factors had been identified, patients were matched according to Fong’s prognostic criteria, in order to evaluate whether R1 resection still remained a negative prognostic factor impacting overall and disease‐free survival.

Methods

A total of 1784 hepatectomies were analyzed from a multicentric retrospective cohort of hepatectomies. Patients were compared before and after a 1:1 propensity score analysis in order to compare R0 versus R1 resections according to Fong criteria.

Results

Primary tumor nodes found positive after colorectal resection (RR = 1.20, p = 0.02), operative time (> 240 min) (RR = 1.26, p = 0.05), synchronous liver metastasis (RR = 1.27, p = 0.02), pedicle clamping (> 40 min) (RR = 1.52, p = 0.001), lesion size larger than 50 mm (RR = 1.54, p = 0.001), rehepatectomy (RR = 1.68, p = 0.001), more than 3 lesions (RR = 1.69, p = 0.0001), and bilateral lesions (RR = 1.74, p = 0.0001) were identified as risk factors in multivariate analysis. After a 1:1 PSM according to Fong criteria, R1 resection still remained a negative prognostic factor impacting overall and disease‐free survival, with 1‐, 3‐, 5‐year OS at 94, 81, and 70% in R0 and 92, 75, and 58% in R1, respectively, (p = 0.008), and disease‐free survival (DFS) with 1‐, 3‐, 5‐year survival at 64, 41, and 28% in R0 versus 51, 28, and 18% in R1 (p = 0.0002), respectively.

Conclusion

Even after using PSM as an oncological prognostic criterion, R1 resection still impacts overall and disease‐free survival negatively.