Influence of Margins on Disease Free Survival Following Hepatic Resection for Colorectal Metastasis: A Meta-Analysis

Abstract

The aim of our study was to conduct a meta-analysis of reports published on hepatic resection for colorectal liver metastases (CRLM) and determine if a negative margin ≥1 cm confers a disease free survival (DFS) advantage over sub-centimeter negative margins. The 357 initially selected articles were screened to identify 90 articles of interest of which eleven were finally included in the meta-analysis. Patients with positive margins were excluded from the meta-analysis. Meta-analysis was performed using STATA 9. 2 statistical software. A total of 1,989 patients with negative margins from the eleven studies were included in the meta-analysis. The 5-year DFS for all patients was 27. 9 % (95 % CI 23. 5 % to 32. 2 %). The 5-year DFS for ≥1 cm negative margin subgroup was 34. 4 % (95 % CI 27. 97 % to 40. 7 %) when compared to 21. 0 % (95 % CI 17. 4 % to 24. 7 %) for <1 cm negative margin subgroup. The odds ratio for ≥1 cm negative margins was found to be 0. 552 (95 % CI 0. 408 to 0. 747, p < 0. 001) when compared to <1 cm negative margins. The results of this meta-analysis demonstrate that in patients undergoing hepatic resection for CRLM, a negative margin ≥ 1 cm may confer a better DFS compared with a sub-centimeter negative margin. © 2012 Indian Association of Surgical Oncology.