• Georgios A Margonis, Theodoros N Sergentanis, Ioannis Ntanasis-Stathopoulos, Nikolaos Andreatos, Ioannis-Georgios Tzanninis, Kazunari Sasaki, Theodora Psaltopoulou, Jaeyun Wang, Stefan Buettner, Αpostolos E Papalois, Jin He, Christopher L Wolfgang, Timothy M Pawlik, and Matthew J Weiss.
• Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.
• Ann. Surg. 2018 Jun 1; 267 (6): 1047-1055.

ObjectiveTo examine the impact of surgical margin width on survival following R0 hepatic resection for colorectal metastases (CRLM).Summary Of Background DataAlthough negative resection margin is considered of paramount importance for the prognosis of patients with colorectal liver metastases, optimal resection margin width remains controversial.MethodsEligible 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).ResultsThirty-four studies were deemed eligible for inclusion representing a cohort of 11,147 hepatic resections. Wider resection margin (>1 vs <1 cm) 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 >1 cm resection margin at 3, 5, and 10 years. Interestingly, >1 mm (vs <1 mm) 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.ConclusionsImportantly, our findings suggest that while a >1 mm margin is associated with better prognosis than a submillimeter margin, achieving a margin >1 cm may result in even better oncologic outcomes and should be considered if possible.

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