Margin Status Remains an Important Determinant of Survival after Surgical Resection of Colorectal Liver Metastases in the Era of Modern Chemotherapy

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dc.contributor.author Andreou, Andreas
dc.contributor.author Aloia, Thomas
dc.contributor.author Brouquet, Antoine
dc.contributor.author Dickson, Paxton
dc.contributor.author Zimmitti, Guiseppe
dc.contributor.author Maru, Dipen
dc.contributor.author Kopetz, Scott
dc.contributor.author Loyer, Evelyne
dc.contributor.author Curley, Steven
dc.contributor.author Abdalla, Eddie
dc.contributor.author Vauthey, Jean-Nicolas
dc.date.accessioned 2015-11-20T10:17:44Z
dc.date.available 2015-11-20T10:17:44Z
dc.date.copyright 2014
dc.date.issued 2015-11-20
dc.identifier.issn 0003-4932 en_US
dc.identifier.uri http://hdl.handle.net/10725/2650
dc.description.abstract Objective To determine the impact of surgical margin status on overall survival (OS) of patients undergoing hepatectomy for colorectal liver metastases (CLM) after modern preoperative chemotherapy. Summary Background Data In the era of effective chemotherapy for CLM, the association between surgical margin status and survival has become controversial. Methods Clinicopathologic data and outcomes for 378 patients treated with modern preoperative chemotherapy and hepatectomy were analyzed. The effect of positive margins on OS was analyzed in relation to pathologic and computed tomography-based morphologic response to chemotherapy. Results Fifty-two of 378 resections (14%) were R1 resections (tumor-free margin < 1 mm). The 5-year OS rates for patients with R0 resection (margin ≥ 1 mm) and R1 resection were 55% and 26%, respectively (P=0.017). Multivariate analysis identified R1 resection (P=0.03) and minor pathologic response to chemotherapy (P=0.002) as the 2 factors independently associated with worse survival. The survival benefit associated with negative margins (R0 vs. R1 resection) was greater in patients with suboptimal morphologic response (5-year OS rate: 62% vs. 11%, P=0.007) than in patients with optimal response (3-year OS rate: 92% vs. 88%, P=0.917) and greater in patients with minor pathologic response (5-year OS rate: 46% vs. 0%, P=0.002) than in patients with major response (5-year OS rate: 63% vs. 67%, P=0.587). Conclusions In the era of modern chemotherapy, negative margins remain an important determinant of survival and should be the primary goal of surgical therapy. The impact of positive margins is most pronounced in patients with suboptimal response to systemic therapy. en_US
dc.language.iso en en_US
dc.title Margin Status Remains an Important Determinant of Survival after Surgical Resection of Colorectal Liver Metastases in the Era of Modern Chemotherapy en_US
dc.type Article en_US
dc.description.version Published en_US
dc.author.school SOM en_US
dc.author.idnumber 201100945 en_US
dc.author.woa N/A en_US
dc.author.department N/A en_US
dc.description.embargo N/A en_US
dc.relation.journal Annals of surgery en_US
dc.journal.volume 257 en_US
dc.journal.issue 6 en_US
dc.article.pages 1079-1088 en_US
dc.identifier.doi http://dx.doi.org/10.1097/SLA.0b013e318283a4d1 en_US
dc.identifier.ctation Andreou, A., Aloia, T. A., Brouquet, A., Dickson, P. V., Zimmitti, G., Maru, D. M., ... & Vauthey, J. N. (2013). Margin status remains an important determinant of survival after surgical resection of colorectal liver metastases in the era of modern chemotherapy. Annals of surgery, 257(6), 1079. en_US
dc.author.email eddie.abdalla@lau.edu.lb
dc.identifier.url http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3654038/

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