Research progress on resection margin of liver metastasis in colorectal cancer

Abstract

Abstract: The resection margin of liver metastases refers to the distance from the tumor edge to the liver section. The liver is the main target organ for distant metastasis of colorectal cancer. The issue of resection margin should not only follow the basic principles of liver surgery, but also consider the unique biological characteristics of colorectal liver metastases. Surgical resection margin is the focus and difficulty in surgical treatment. The definition of R0 resection has undergone a shift from a margin greater than 1 cm to greater than 1 mm. With further research, tumor R1 resection has gradually been proposed and accepted under specific conditions. High tumor burden, RAS gene mutations, tumor pathology, and vascular relationships are associated with higher R1 resection rates. This article intends to review and analyze the study of surgical margins for liver metastases in colorectal cancer.

Key words: Colorectal cancer, Liver metastasis, Surgical margin

Han Jixiang, Zhao Jianjun, Wang Jingtao. Research progress on resection margin of liver metastasis in colorectal cancer[J]. Electronic Journal of Liver Tumor, 2025, 12(2): 26-29.

References

[1] QIN S, LIU G J, HUANG M, et al.The local efficacy and influencing factors of ultrasound-guided percutaneous microwave ablation in colorectal liver metastases: a review of a 4-year experience at a single center[J]. Int J Hyperthermia, 2019, 36(1): 36-43.
[2] STEWART C L, WARNER S, ITO K, et al.Cytoreduction for colorectal metastases: liver, lung, peritoneum, lymph nodes, bone, brain. When does it palliate, prolong survival, and potentially cure?[J]. Curr Probl Surg, 2018, 55(9): 330-379.
[3] MARGONIS G A, SERGENTANIS T N, NTANASIS-STATHOPOULOS I, et al.Impact of surgical margin width on recurrence and overall survival following R0 hepatic resection of colorectal metastases: a systematic review and meta-analysis[J]. Ann Surg, 2018, 267(6): 1047-1055.
[4] 中国医师协会外科医师分会,中华医学会外科学分会胃肠外科学组,中华医学会外科学分会结直肠外科学组,等. 中国结直肠癌肝转移诊断和综合治疗指南(2023版)[J]. 中国实用外科杂志,2023,43(1):9-22.
[5] HAMMOND J S, GUHA I N, BECKINGHAM I J, et al.Prediction, prevention and management of postresection liver failure[J]. Br J Surg, 2011, 98(9): 1188-1200.
[6] FABER W, SEEHOFER D, NEUHAUS P, et al.Repeated liver resection for recurrent hepatocellular carcinoma[J]. J Gastroenterol Hepatol, 2011, 26(7): 1189-1194.
[7] REGISTRY OF HEPATIC METASTASES. Resection of the liver forcolorectal carcinoma metastases: a multi-institutional study of indications for resection. Registry of hepatic metastases[J]. Surgery, 1988, 103(3): 278-288.
[8] PAWLIK T M, SCOGGINS C R, ZORZI D, et al.Effect of surgical margin status on survival and site of recurrence after hepatic resection for colorectal metastases[J]. Ann Surg, 2005, 241(5): 715-724.
[9] HAMADY Z Z, CAMERON I C, WYATT J, et al.Resection margin in patients undergoing hepatectomy for colorectal liver metastasis: a critical appraisal of the 1cm rule[J]. Eur J Surg Oncol, 2006, 32(5): 557-563.
[10] VAN CUTSEM E, CERVANTES A, ADAM R, et al.ESMO consensus guidelines for the management of patients with metastatic colorectal cancer[J]. Ann Oncol, 2016, 27(8): 1386-1422.
[11] DE HAAS R J, WICHERTS D A, FLORES E, et al. R1 resection by necessity for colorectal liver metastases: is it still a contraindication to surgery?[J]. Ann Surg, 2008, 248(4): 626-637.
[12] WANG J, MARGONIS G A, AMINI N, et al.The prognostic value of varying definitions of positive resection margin in patients with colorectal cancer liver metastases[J]. J Gastrointest Surg, 2018, 22(8): 1350-1357.
[13] VIGANÒ L, COSTA G, CIMINO M M, et al.R1 Resection for Colorectal Liver Metastases: a Survey Questioning Surgeons about Its Incidence, Clinical Impact, and Management[J]. J Gastrointest Surg, 2018, 22(10): 1752-1763.
[14] MARGONIS G A, SPOLVERATO G, KIM Y, et al.Intraoperative surgical margin re-resection for colorectal liver metastasis: is it worth the effort?[J]. J Gastrointest Surg, 2015, 19(4): 699-707.
[15] TRUANT S, SÉQUIER C, LETEURTRE E, et al. Tumour biology of colorectal liver metastasis is a more important factor in survival than surgical margin clearance in the era of modern chemotherapy regimens[J]. HPB (Oxford), 2015, 17(2): 176-184.
[16] RAHBARI N N, BIRGIN E, BORK U, et al.Anterior approach vs conventional hepatectomy for resection of colorectal liver metastasis: a randomized clinical trial[J]. JAMA Surg, 2021, 156(1): 31-40.
[17] AYEZ N, LALMAHOMED Z S, EGGERMONT A M, et al.Outcome of microscopic incomplete resection (R1) of colorectal liver metastases in the era of neoadjuvant chemotherapy[J]. Ann Surg Oncol, 2012, 19(5): 1618-1627.
[18] 艾向南,王行雁,张文轩,等.肝脏R1 切缘对结直肠癌肝转移肝内复发的影响[J/CD]. 肝癌电子杂志,2024,11(2):37-42.
[19] ZIZZO M, GALEONE C, BRAGLIA L, et al.Long-term outcomes after surgical resection for synchronous or metachronous hepatic and pulmonary colorectal cancer metastases[J]. Digestion, 2020, 101(2): 144-155.
[20] SASAKI K, MARGONIS G A, MAITANI K, et al.The prognostic impact of determining resection margin status for multiple colorectal metastases according to the margin of the largest lesion[J]. Ann Surg Oncol, 2017, 24(9): 2438-2446.
[21] NIEROP P M H, HÖPPENER D J, VAN DER STOK E P, et al. Histopathological growth patterns and positive margins after resection of colorectal liver metastases[J]. HPB (Oxford), 2020, 22(6): 911-919.
[22] MARGONIS G A, BUETTNER S, ANDREATOS N, et al.Anatomical resections improve disease-free survival in patients with kras-mutated colorectal liver metastases[J]. Ann Surg, 2017, 266(4): 641-649.
[23] SORICH M J, WIESE M D, ROWLAND A, et al.Extended RAS mutations and anti-EGFR monoclonal antibody survival benefit in metastatic colorectal cancer: a meta-analysis of randomized, controlled trials[J]. Ann Oncol, 2015, 26(1): 13-21.
[24] BRUDVIK K W, MISE Y, CHUNG M H, et al.RAS mutation predicts positive resection margins and narrower resection margins in patients undergoing resection of colorectal liver metastases[J]. Ann Surg Oncol, 2016, 23(8): 2635-2643.
[25] ZHANG Q, PENG J, YE M, et al.KRAS mutation predicted more mirometastases and closer resection margins in patients with colorectal cancer liver metastases[J]. Ann Surg Oncol, 2020, 27(4): 1164-1173.
[26] SEROVA M, ASTORGUES-XERRI L, BIECHE I, et al.Epithelial- to-mesenchymal transition and oncogenic Ras expression in resistance to the protein kinase Cbeta inhibitor enzastaurin in coloncancer cells[J]. Mol Cancer Ther, 2010, 9(5): 1308-1317.
[27] MARGONIS G A, SASAKI K, KIM Y, et al.Tumor biology rather than surgical technique dictates prognosis in colorectal cancer liver metastases[J]. J Gastrointest Surg, 2016, 20(11): 1821-1829.
[28] VAN CUTSEM E, CERVANTES A, NORDLINGER B, et al. Metastatic colorectal cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up[J]. Ann Oncol, 2014, 25(Suppl 3): ili1-ili9.
[29] VIGANÒ L, PROCOPIO F, CIMINO M M, et al.Is tumor detachment from vascular structures equivalent to r0 resection in surgery for colorectal liver metastases? An observational cohort[J]. Ann Surg Oncol, 2016, 23(4): 1352-1360.