Colorectal Cancer Liver Metastases: Is an R1 Hepatic Resection Accepted?
Metastatic colorectal cancer is associated with a rather dismal 5-year overall survival. The liver is the most commonly affected organ. Improved 5-year survival rates after successful hepatic resections for metastases confined to the liver have been reported. Certainly, a hepatectomy that results in...
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| Format: | Article |
| Language: | English |
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MDPI AG
2022-12-01
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| Series: | Clinics and Practice |
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| Online Access: | https://www.mdpi.com/2039-7283/12/6/112 |
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| author | Dimitrios Symeonidis Konstantinos Tepetes George Tzovaras Labrini Kissa Athina A. Samara Effrosyni Bompou Dimitrios Zacharoulis |
| author_facet | Dimitrios Symeonidis Konstantinos Tepetes George Tzovaras Labrini Kissa Athina A. Samara Effrosyni Bompou Dimitrios Zacharoulis |
| author_sort | Dimitrios Symeonidis |
| collection | DOAJ |
| description | Metastatic colorectal cancer is associated with a rather dismal 5-year overall survival. The liver is the most commonly affected organ. Improved 5-year survival rates after successful hepatic resections for metastases confined to the liver have been reported. Certainly, a hepatectomy that results in an incomplete tumor resection, in terms of leaving macroscopic residual tumor in the future liver remnant, is not associated with survival benefits. However, the prognostic implications of a microscopically positive surgical margin or a clear margin of less than 1 mm (R1) on pathology are debatable. Although it has been a field of extensive research, the relevant literature often reports contradictory results. The purpose of the present study was to define, assess the risk factors for, and, ultimately, analyze the effect that an R1 hepatic resection for colorectal cancer liver metastases might have on local recurrence rates and long-term prognosis by reviewing the relevant literature. Achieving an R0 hepatic resection, optimally with more than 1 mm of clear margin, should always be the goal. However, in the era of the aggressive multimodality treatment of liver metastatic colorectal cancer, an R1 resection might be the cost of increasing the pool of patients finally eligible for resection. The majority of literature reports have highlighted the detrimental effect of R1 resections on local recurrence and overall survival. However, there are indeed studies that degraded the prognostic handicap as a consequence of an R1 resection in selected patients and highlighted the presence of RAS mutations, the response to chemotherapy, and, in general, factors that reflect the biology of the disease as important, if not the determinant, prognostic factors. In these patients, the aggressive disease biology seems to outperform the resection margin status as a prognostic factor, and the recorded differences between R1 and R0 resections are equalized. Properly and accurately defining this patient group is a future challenge in the field of the surgical treatment of colorectal cancer liver metastases. |
| first_indexed | 2024-03-09T17:10:10Z |
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| id | doaj.art-4174059b8496493ebb82cada9adf80a3 |
| institution | Directory Open Access Journal |
| issn | 2039-7283 |
| language | English |
| last_indexed | 2024-03-09T17:10:10Z |
| publishDate | 2022-12-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Clinics and Practice |
| spelling | doaj.art-4174059b8496493ebb82cada9adf80a32023-11-24T14:05:28ZengMDPI AGClinics and Practice2039-72832022-12-011261102111010.3390/clinpract12060112Colorectal Cancer Liver Metastases: Is an R1 Hepatic Resection Accepted?Dimitrios Symeonidis0Konstantinos Tepetes1George Tzovaras2Labrini Kissa3Athina A. Samara4Effrosyni Bompou5Dimitrios Zacharoulis6Department of Surgery, University Hospital of Larissa, Mezourlo, 41110 Larissa, GreeceDepartment of Surgery, University Hospital of Larissa, Mezourlo, 41110 Larissa, GreeceDepartment of Surgery, University Hospital of Larissa, Mezourlo, 41110 Larissa, GreeceDepartment of Surgery, University Hospital of Larissa, Mezourlo, 41110 Larissa, GreeceDepartment of Surgery, University Hospital of Larissa, Mezourlo, 41110 Larissa, GreeceDepartment of Surgery, University Hospital of Larissa, Mezourlo, 41110 Larissa, GreeceDepartment of Surgery, University Hospital of Larissa, Mezourlo, 41110 Larissa, GreeceMetastatic colorectal cancer is associated with a rather dismal 5-year overall survival. The liver is the most commonly affected organ. Improved 5-year survival rates after successful hepatic resections for metastases confined to the liver have been reported. Certainly, a hepatectomy that results in an incomplete tumor resection, in terms of leaving macroscopic residual tumor in the future liver remnant, is not associated with survival benefits. However, the prognostic implications of a microscopically positive surgical margin or a clear margin of less than 1 mm (R1) on pathology are debatable. Although it has been a field of extensive research, the relevant literature often reports contradictory results. The purpose of the present study was to define, assess the risk factors for, and, ultimately, analyze the effect that an R1 hepatic resection for colorectal cancer liver metastases might have on local recurrence rates and long-term prognosis by reviewing the relevant literature. Achieving an R0 hepatic resection, optimally with more than 1 mm of clear margin, should always be the goal. However, in the era of the aggressive multimodality treatment of liver metastatic colorectal cancer, an R1 resection might be the cost of increasing the pool of patients finally eligible for resection. The majority of literature reports have highlighted the detrimental effect of R1 resections on local recurrence and overall survival. However, there are indeed studies that degraded the prognostic handicap as a consequence of an R1 resection in selected patients and highlighted the presence of RAS mutations, the response to chemotherapy, and, in general, factors that reflect the biology of the disease as important, if not the determinant, prognostic factors. In these patients, the aggressive disease biology seems to outperform the resection margin status as a prognostic factor, and the recorded differences between R1 and R0 resections are equalized. Properly and accurately defining this patient group is a future challenge in the field of the surgical treatment of colorectal cancer liver metastases.https://www.mdpi.com/2039-7283/12/6/112colorectal cancer liver metastasesresection marginsR0 resectionR1 resection |
| spellingShingle | Dimitrios Symeonidis Konstantinos Tepetes George Tzovaras Labrini Kissa Athina A. Samara Effrosyni Bompou Dimitrios Zacharoulis Colorectal Cancer Liver Metastases: Is an R1 Hepatic Resection Accepted? Clinics and Practice colorectal cancer liver metastases resection margins R0 resection R1 resection |
| title | Colorectal Cancer Liver Metastases: Is an R1 Hepatic Resection Accepted? |
| title_full | Colorectal Cancer Liver Metastases: Is an R1 Hepatic Resection Accepted? |
| title_fullStr | Colorectal Cancer Liver Metastases: Is an R1 Hepatic Resection Accepted? |
| title_full_unstemmed | Colorectal Cancer Liver Metastases: Is an R1 Hepatic Resection Accepted? |
| title_short | Colorectal Cancer Liver Metastases: Is an R1 Hepatic Resection Accepted? |
| title_sort | colorectal cancer liver metastases is an r1 hepatic resection accepted |
| topic | colorectal cancer liver metastases resection margins R0 resection R1 resection |
| url | https://www.mdpi.com/2039-7283/12/6/112 |
| work_keys_str_mv | AT dimitriossymeonidis colorectalcancerlivermetastasesisanr1hepaticresectionaccepted AT konstantinostepetes colorectalcancerlivermetastasesisanr1hepaticresectionaccepted AT georgetzovaras colorectalcancerlivermetastasesisanr1hepaticresectionaccepted AT labrinikissa colorectalcancerlivermetastasesisanr1hepaticresectionaccepted AT athinaasamara colorectalcancerlivermetastasesisanr1hepaticresectionaccepted AT effrosynibompou colorectalcancerlivermetastasesisanr1hepaticresectionaccepted AT dimitrioszacharoulis colorectalcancerlivermetastasesisanr1hepaticresectionaccepted |