Prospective Non-Randomized Study of Intraoperative Assessment of Surgical Resection Margin of Colo-Rectal Liver Metastases

Abstract

The resection margin (RM) after resection of colorectal liver metastases (CRLM) can be assessed by the pathologist on the resected liver specimen (RLS) and by the surgeon intraoperatively. The aim of this study is to determine the degree of agreement on surgical (SA) and pathological (PA) assessment of the RM. This is prospective non-randomized double-blind study, CTG #NCT04634526. The study was conducted at the Oncology Institute of Vojvodina, Sremska Kamenica, Serbia. Experienced surgeons and pathologists assessed RM for every RLS. PA was a “gold standard”. RM of 1 mm or more was rated as negative (RM-). From 01 January 2015 to 30 April 2021, 170 patients were enrolled in the study with 376 RLS. Sensitivity of SA of RM+ was 56.9% (49/86) and specificity was 94.8% (275/290). There is moderate agreement in the assessment of RM+ between SA and PA (kappa test= 0.569). Recurrence rate for RM+ patients was 55,3% (21/38, p=0.029) for SA and 48.3% (29/60, p=0.103) for PA. Three years DFS for RM- and RM+ was 41.4% and 35.6% (p=0.014), respectively, by SA, and 42.3% and 31.4% (p=0.375), respectively, by PA. Means for DFS for RM- and RM+ was 29.6±2.25 months and 19.4±2,31 months by SA. Means for DFS for RM- and RM+ was 29.9±2,62 months and 22.2 ± 1.95 months by PA. Intraoperative assessment of RM- by surgeon of RLS is clinically meaningful. RM determined by surgeon has better prognostic impact on recurrence rate and 1- and 3-year DFS than standard histopathological assessment.