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

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Meta-Analysis
Neoplasm Metastasis
Recurrence
Survival
Liver
Disease-Free Survival
Margins of Excision
Databases
Confidence Intervals

Keywords

  • margin
  • meta-analysis
  • prognosis

ASJC Scopus subject areas

  • Surgery

Cite this

Margonis, G. A., Sergentanis, T. N., Ntanasis-Stathopoulos, I., Andreatos, N., Tzanninis, I. G., Sasaki, K., ... 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

Impact of Surgical Margin Width on Recurrence and Overall Survival Following R0 Hepatic Resection of Colorectal Metastases : A Systematic Review and Meta-analysis. / Margonis, Georgios A.; Sergentanis, Theodoros N.; Ntanasis-Stathopoulos, Ioannis; Andreatos, Nikolaos; Tzanninis, Ioannis Georgios; Sasaki, Kazunari; Psaltopoulou, Theodora; Wang, Jaeyun; Buettner, Stefan; Papalois, Apostolos E.; He, Jin; Wolfgang, Christopher; Pawlik, Timothy M.; Weiss, Matthew J.

In: Annals of Surgery, Vol. 267, No. 6, 01.06.2018, p. 1047-1055.

Research output: Contribution to journalArticle

Margonis, GA, Sergentanis, TN, Ntanasis-Stathopoulos, I, Andreatos, N, Tzanninis, IG, Sasaki, K, Psaltopoulou, T, Wang, J, Buettner, S, Papalois, AE, He, J, Wolfgang, C, Pawlik, TM & Weiss, MJ 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, vol. 267, no. 6, pp. 1047-1055. https://doi.org/10.1097/SLA.0000000000002552
Margonis, Georgios A. ; Sergentanis, Theodoros N. ; Ntanasis-Stathopoulos, Ioannis ; Andreatos, Nikolaos ; Tzanninis, Ioannis Georgios ; Sasaki, Kazunari ; Psaltopoulou, Theodora ; Wang, Jaeyun ; Buettner, Stefan ; Papalois, Apostolos E. ; He, Jin ; Wolfgang, Christopher ; Pawlik, Timothy M. ; Weiss, Matthew J. / Impact of Surgical Margin Width on Recurrence and Overall Survival Following R0 Hepatic Resection of Colorectal Metastases : A Systematic Review and Meta-analysis. In: Annals of Surgery. 2018 ; Vol. 267, No. 6. pp. 1047-1055.
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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.",
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T2 - A Systematic Review and Meta-analysis

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AU - Sergentanis, Theodoros N.

AU - Ntanasis-Stathopoulos, Ioannis

AU - Andreatos, Nikolaos

AU - Tzanninis, Ioannis Georgios

AU - Sasaki, Kazunari

AU - Psaltopoulou, Theodora

AU - Wang, Jaeyun

AU - Buettner, Stefan

AU - Papalois, Apostolos E.

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AU - Wolfgang, Christopher

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AU - Weiss, Matthew J

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