Impact of Surgical Margin Width on Recurrence and Overall Survival Following R0 Hepatic Resection of Colorectal Metastases: A Systematic Review and Meta-analysis

Georgios A. Margonis, Theodoros N. Sergentanis, Ioannis Ntanasis-Stathopoulos, Nikolaos Andreatos, Ioannis Georgios Tzanninis, Kazunari Sasaki, Theodora Psaltopoulou, Jaeyun Wang, Stefan Buettner, Apostolos E. Papalois, Jin He, Christopher Wolfgang, Timothy M. Pawlik, Matthew J Weiss

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish (US)
Pages (from-to)1047-1055
Number of pages9
JournalAnnals of Surgery
Volume267
Issue number6
DOIs
StatePublished - Jun 1 2018

Keywords

  • margin
  • meta-analysis
  • prognosis

ASJC Scopus subject areas

  • Surgery

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    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., Pawlik, T. M., & Weiss, M. J. (2018). Impact of Surgical Margin Width on Recurrence and Overall Survival Following R0 Hepatic Resection of Colorectal Metastases: A Systematic Review and Meta-analysis. Annals of Surgery, 267(6), 1047-1055. https://doi.org/10.1097/SLA.0000000000002552