Surgical margin in hepatic resection for colorectal XXXX : a critical and improvable determinant of outcome.

@entity1 @entity75 @entity190 @entity409 @entity787 @entity14 @entity3
OBJECTIVE: To update the analysis of technical and biologic factors related to hepatic resection for colorectal @entity3 in a large single-institution series to identify important prognostic indicators and patterns of failure. SUMMARY BACKGROUND DATA: Surgical therapy for @entity14 metastatic to the liver is the only potentially curable treatment. Careful @entity1 selection of those with resectable liver-only metastatic disease is crucial to the success of surgical therapy. METHODS: Two hundred forty-four consecutive @entity1 undergoing curative hepatic resection for metastatic @entity14 were analyzed retrospectively. Variables examined included sex, stage of @entity75 , size of @entity409 (s), number of lesions, disease-free interval, ploidy, differentiation, preoperative @entity787 level, and operative factors such as resection margin, use of cryotherapy, intraoperative ultrasound, and @entity190 . RESULTS: Surgical margin, number of lesions, and @entity787 ( @entity787 ) levels significantly control prognosis. @entity1 with only one or two liver lesions, a 1-cm surgical margin, and low @entity787 levels have a 5-year disease-free survival rate of more than 30%. Disease-free interval, original stage, bilobar involvement, size of @entity3 , differentiation, and ploidy were not significant predictors of recurrence. The pattern of failure correlates with surgical margin. Routine use of intraoperative ultrasound resulted in an increased incidence of negative surgical margin during the period examined. CONCLUSIONS: Surgical resection or cryotherapy of hepatic @entity3 from @entity14 is safe and curable in appropriately selected @entity1 . Biologic factors, such as number of lesions and @entity787 levels, determine potential curability, and surgical margin governs the patterns of failure and outcome in potentially curable @entity1 . Optimization of selection criteria and surgical resection margins will improve outcome.
