Impact of surgical margins on overall and disease-free survival in parenchyma-saving laparoscopic liver resections withthe surgical aspirator for colorectal metastases

Introduction: The relationships between surgical margins and local/distant recurrence of colorectal liver metastases (CRLM) remain controversial. The impact of surgical margins in laparoscopic liver resections (LLR) for CRLM with the surgical aspirator on overall (OS) and disease-free (DFS) survival has never been evaluated. We focus our experience on this issue. Method: From 2005 to 2012, 116 first LLR for CRLM were analyzed retrospectively. M/F ratio was of 69/ 31% and the mean age of 67y. Chemotherapy was given in 93% of patients. R1 margins were defined as a cutting edge <1 mm. Results: Major resection rate was 16%; the mean surgical time was of 112 282 min and the mean blood loss of 480 675 cc; the Pringle manoeuver was needed in 9.4% and the conversion rate was of 15.5%, mainly for oncological reasons. The mean hospital stay was of 6.1 3 days. The mean nodules number was of 1.7 1.2 (range 1–7), and the total size was of 40.9 31 mm (range 3.5–145). The mean margin distance was of 6.3 7.6 mm (range 0–40), R1 was recorded in 14 (12.1%) cases. In case of hepatic recurrence (27 pts) repeated hepatectomy was done in 63% of cases. Local recurrence was similar in R0 and R1 (39% vs. 46.1%, p = 0.43). After a mean follow up of 30 18.5 months, overall survival was 98–75.1–59% at 1–3–5 years respectively. R1 margins were not significantly related to the DFS survival but to a lower OS (p = 0.05). Multivariate analysis showed major hepatectomy and total lesions diameter as independent variables for DFS (p = 0.04 and <0.001 respectively). Conclusions: Parenchyma-saving surgery with the surgical aspirator do not worse the oncological outcome allowing a higher percentage of redo-hepatectomy. In this context, the oncological results of patients with R1 margins receiving a parenchyma-saving surgery with perioperative chemotherapy are not compromised