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KRAS Mutation Status Dictates Optimal Surgical Margin Width in Patients Undergoing Resection of Colorectal Liver Metastases.

Abstract：

BACKGROUND:The optimal tumor-free margin width remains controversial and may be inappropriate to investigate without considering differences in the underlying tumor biology. METHODS:R1 resection was defined as margin clearance less than 1 mm. R0 resection was further divided into 3 groups: 1-4, 5-9, and ≥10 mm. The impact of margin width on overall survival (OS) relative to KRAS status [wild type (wtKRAS) vs. mutated (mutKRAS)] was assessed. RESULTS:A total of 411 patients met inclusion criteria. Median patient age was 58 years (interquartile range, 49.7-66.7); most patients were male (n = 250; 60.8 %). With a median follow-up of 28.3 months, median and 5-year OS were 69.8 months and 55.1 %. Among patients with wtKRAS tumors, although margin clearance of 1-4 mm or more was associated with improved OS compared to R1 (all P < 0.05), no difference in OS was observed when comparing margin clearance of 1-4 mm to the 5-9 mm and the ≥10 mm groups (all P > 0.05). In contrast, among patients with mutKRAS tumors, all three groups of margin clearance (1-4, 5-9, and ≥10 mm) fared no better in terms of 5-year survival compared to R1 resection (all P > 0.05). CONCLUSIONS:While a 1-4 mm margin clearance in patients with wtKRAS tumors was associated with improved survival, wider resection width did not confer an additional survival benefit. In contrast, margin status-including a 1 cm margin-did not improve survival among patients with mutKRAS tumors.

journal_name

Ann Surg Oncol

journal_title

Annals of surgical oncology

authors

Margonis GA,Sasaki K,Andreatos N,Kim Y,Merath K,Wagner D,Wilson A,Buettner S,Amini N,Antoniou E,Pawlik TM

doi

10.1245/s10434-016-5609-1

subject

Has Abstract

pub_date

2017-01-01 00:00:00

pages

264-271

issue

1

eissn

1068-9265

issn

1534-4681

pii

10.1245/s10434-016-5609-1

journal_volume

24

pub_type

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