Surgery News - November 2007 - (Page 8)

8 ONCOLOGY SURGERY NEWS • N O V E M B E R 2 0 0 7 Reconsider Margin for Colorectal Liver Metastases B Y K AT E J O H N S O N Else vier Global Medical Ne ws M O N T R E A L — A surgical margin of 10 mm for the excision of colorectal liver metastases may no longer be necessary and should not be considered a prerequisite for surgical candidates, according to results from two different studies presented at a meeting sponsored by the International Society of Surgery. “In the past, if a surgeon felt preoperatively that it was not possible to resect a tu- mor with a 10-mm margin, the surgery might not be performed at all,” said Dr. Andrea Frilling, a surgeon from the University of Essen, Germany. But her study found no difference in overall and tumor-free survival among patients with 6- to 10-mm margins vs. patients with 1- to 5-mm margins. At 5 years, tumor-free survival was 26% in patients with the larger margin, and 28% in those with a smaller margin. These results are comparable with those of patients with margins exceeding 10 mm, she noted. The analysis, which included 482 patients, nevertheless reinforced the importance of at least some surgical margin. The 101 patients with nonresectable disease had a lower 5-year survival rate than did the 381 patients with resectable disease (10% vs. 30%). And among all patients with resectable disease, the 292 who had negative margins (R0) had a 5-year survival rate of 40%, compared with 21% for the 89 patients with microscopically positive margins (R1), she reported. In a separate study, researchers agreed H E R E ’ S W H Y I T ’ S I M P O R TA N T: AS A BODY REPRESENTING ALL OF SURGERY, THE COLLEGE: • Provides a cohesive voice addressing societal issues related to surgery. • Is working toward having an increasingly proactive and timely voice in setting a national tone and agenda with regard to health care. • Is dedicated to promoting the highest standards of surgical care through education of and advocacy for its Fellows and their patients. • Serves as a national forum through which surgeons can reinforce the values and ethics that traditionally have characterized the surgical profession. HERE ARE SOME OF THE MANY BENEFITS BEING A MEMBER OF THE COLLEGE AFFORDS YOU: • Free registration at the Clinical Congress • Access to the College’s free coding consultation hotline • Subscription to ACS NewsScope, the College’s weekly electronic newsletter • Subscription to the Bulletin of the American College of Surgeons • Subscription to the Journal of the American College of Surgeons • Access to all College-sponsored insurance, credit card, and other helpful programs • Free posting of resume on ACS Career Opportunities • Access to Surgeons Diversiﬁed Investment Fund Postsurgery specimen with a resection margin of >10 mm. THERE IS STRENGTH IN NUMBERS. Our members represent every specialty, practice setting, and stage of practice. Their views and concerns are helping to shape the College’s agenda for the future. If you aren’t a member of the American College of Surgeons, apply for Fellowship today. If you are already a member, maintain that status and consider getting involved in the work of the College. Only by banding together and using our collective strength can we bring about positive change for our patients and ourselves—and for surgeons of the future. Information on becoming a member of the College and an application form are available online at w w w.f ac s .org/dept /fellowship/index .html or contact Cynthia Hicks, Credentials Section, Division of Member Services, via phone at 1-800/293-9623, or via e-mail at chicks@facs.org. margins of 2 mm or less had a significantly increased risk of tumor recurrence in the liver (OR 2.0) or anywhere (OR 1.6). “There are several contradictory publications with different results about prognostic parameters in colorectal liver metastases resection,” Dr. Konopke said in an interview. “In comparison to Dr. Frilling, we differentiated the resection margins in more groups: 0 mm, 1-2 mm, 3-5 mm, 69 mm, and greater than 10 mm. Since the critical margin seems to be at 3 mm, this could have confounded her results.” In addition, Dr. Frilling’s study excluded all patients whose operations were performed using surgical devices. “We exclusively looked at patients who underwent liver resection with one of the modern, selective methods of liver parenchymal dissection, such as water jet, CUSA [Cavitron ultrasonic surgical aspirator], or Ultracision,” Dr. Konopke said. “When discussing the surgical margin as a prognostic factor one has to consider the technique of parenchymal transection,” said Dr. Frilling in an interview. “Ultrasound dissector can vaporize or destroy the tissue. This can lead to an overestimation of the number of patients with positive margins. [Because we were] aware of the uncertainty related to the technical devices, we included only those patients in which tissue was transected exclusively by knife or scissors. That means the pathologist had the possibility of examining ‘true’ margins without any artifact caused by ultrasound.” ■ COURTESY DR. RALF KONOPKE Membership in the American College of Surgeons? that a 10-mm margin was not necessary; however, “margins of 2 mm or less should be avoided” because of a poor prognosis, said Dr. Ralf Konopke of the University of Dresden, Germany. His study included 333 patients who underwent resection of colorectal liver metastases and who were followed for a median of 28 months. Compared with 304 patients with negative margins, patients who had incomplete resections had an increased risk of hepatic recurrence (odds ratio 2.3) and recurrence at any location (OR 2.5). The study showed no difference in survival between the two groups, likely because of the short follow-up, Dr. Konopke said. When patients with R0 margins were subdivided according to margin size, all patients with margins of 3 mm or more showed similar overall survival (median 41 months) and recurrence-free survival (median 24 months), whereas patients with http://www.facs.org/dept/fellowship/index.html http://www.facs.org/dept/fellowship/index.html

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Surgery News - November 2007 Contents Black Patients Fare Worse Than Whites After Liver Surgery Survey Suggests Need For Acute Care Surgery New Law Bolsters FDA Funding, Authority Working Together Oncology: Marginal Evidence? Trauma: Screening Scrutinized News From the College: Healy Takes Helm

Surgery News - November 2007

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