CRC liver metastasis: when is R1 resection adequate?

  • Xu D & al.
  • Eur J Surg Oncol
  • 9 Mar 2019

  • curated by Jim Kling
  • Univadis Clinical Summaries
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Takeaway

  • In colorectal cancer (CRC) liver metastases, submillimeter margins (R1) led to similar outcomes to ≥1 mm margins (R0) in RAS wild-type patients who responded to neoadjuvant chemotherapy (NACT).
  • Outcomes were worse with R1 resection in patients with a RAS mutation or no response to NACT.

Why this matters

  • The authors suggest that R1 margins are only acceptable for RAS wild-type tumors that respond to NACT.

Study design

  • Retrospective analysis of 214 patients with initially resectable CRC liver metastases who underwent liver resection after receiving NACT.
  • Funding: Chinese government; Chinese Society of Clinical Oncology-MERCK SERONO Oncology Research Fund.

Key results

  • Among patients with response to chemotherapy (RC), OS was similar between R0 and R1 resections, but OS was lower with R1 among NACT nonresponders (5-year OS; 24.4% vs 12.8%; P=.022).
  • OS was worse with R1 vs R0 resection in RAS+ NACT responders, wild-type RAS nonresponders, and RAS+ nonresponders.
  • For NACT responders with wild-type RAS, there was no difference in 5-year OS between R0 and R1 (66.4% vs 65.2%; P=.884).

Limitations

  • Retrospective analysis.

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