• Thomas Perrin, Sarah M McIntyre, Fiona Ehrich, Jon Heiselman, Eric P van der Stok, Megan Fiasconaro, Mithat Gönen, Jinru Shia, T Peter Kingham, Vinod P Balachandran, Jeffrey A Drebin, Alice C Wei, William R Jarnagin, and Michael I D'Angelica.
• Hepatopancreatobiliary Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
• Ann. Surg. 2025 Feb 10.

ObjectiveTo enhance understanding of the relationships between margin width, recurrence patterns, recurrence-free survival, and salvage therapy following initial hepatectomy for colorectal liver metastases (CRLM).BackgroundThe prognostic implications of the technical aspects of CRLM have not been well-characterized.MethodsA prospective database of 1776 patients who underwent complete resection for CRLM at a single institution (1991-2012) was studied. Pathologic margins were divided into positive, <1 mm, 1.0-9.9 mm, and ≥10 mm groups. Recurrence-free survival, patterns of initial and overall recurrence, including recurrence at the resection margin, and chance for salvage therapy, defined as complete eradication of recurrent disease, were compared by margin group.ResultsMargin status was independently associated with an initial isolated liver recurrence (hazard ratio [HR][95% CI] for positive, <1 mm, 1-9.9 mm vs.≥10 mm margin: 2.21[1.49-3.26],1.42[0.84-2.40],1.41[1.08-1.84];P=0.001). Margin status was also independently associated with risk of initial recurrence at the resection margin (HR[95% CI] for positive, <1 mm, 1-9.9 mm vs.≥10 mm margin: 2.11[1.26-3.54],2.99[1.74-5.15],0.92[0.62-1.37];P<0.001) and risk of liver recurrence at any time (HR[95% CI] for positive, <1 mm, 1-9.9 mm vs.≥10 mm margin: 2.32[1.79-3.01],1.72[1.23-2.42],1.33[1.11-1.58];P<0.001). Estimated 3-year cumulative incidence of overall recurrence at any site in the positive, <1 mm, 1-9.9 mm, and ≥10 mm margin groups was 70%, 70%, 57% , and 50%, respectively. Salvage therapy after recurrence increased with margin width(P<0.001).ConclusionPathologic margin after resection of CRLM is associated with higher rates of overall recurrence that are less amenable to salvage and not just local failure. Margin status may be more of a reflection of underlying tumor characteristics rather than simply a risk factor for local failure.Copyright © 2025 Wolters Kluwer Health, Inc. All rights reserved.

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