Surgical Margins

Outcome of an R0 versus R1 resection

Commentator: RENÉ ADAM, MD

Comment:

Our experience with R1 versus R0 resection was recently described in the October issue of Annals of Surgery. Briefly, overall survival is comparable between R1 and R0 resection, despite the fact that more recurrences were seen in the R1 group compared to the R0 group. Still, the benefit in survival between the groups was the same.

Complete clinical response to neoadjuvant therapy for patients with hepatic metastases

Commentator: AXEL GROTHEY, MD

Comment:

Data show that when a patient with hepatic metastases experiences a complete imaging response to preoperative therapy, if you can identify and resect the area where the lesions were, you will find viable tumor in 85 to 90 percent. The problem is that when you intraoperatively examine this large organ — which has some architectural changes secondary to the chemotherapy — it’s difficult to identify the areas of metastases, especially if there’s a complete response even by ultrasound. If the lesions were confined to one lobe, then you have the choice to either resect the lobe or to perform minimally invasive surgery, follow the patient and resect the lesions if they recur.

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