What is the significance of the circumferential margin in locally advanced rectal cancer after neoadjuvant chemoradiotherapy? Journal Article


Authors: Trakarnsanga, A.; Gonen, M.; Shia, J.; Goodman, K. A.; Nash, G. M.; Temple, L. K.; Guillem, J. G.; Paty, P. B.; Garcia-Aguilar, J.; Weiser, M. R.
Article Title: What is the significance of the circumferential margin in locally advanced rectal cancer after neoadjuvant chemoradiotherapy?
Abstract: Background: The circumferential resection margin (CRM) is highly prognostic for local recurrence in rectal cancer surgery without neoadjuvant treatment. However, its significance in the setting of long-course neoadjuvant chemoradiotherapy (nCRT) is not well defined. Methods: Review of a single institution's prospectively maintained database from 1998 to 2007 identified 563 patients with locally advanced rectal cancer (T3/T4 and/or N1) receiving nCRT, followed after 6 weeks by total mesorectal excision (TME). Kaplan-Meier, Cox regression, and competing risk analysis were performed. Results: The authors noted that 75 % of all patients had stage III disease as determined by endorectal ultrasound (ERUS) and/or magnetic resonance imaging (MRI). With median follow-up of 39 months after resection, local and distant relapse were noted in 12 (2.1 %) and 98 (17.4 %) patients, respectively. On competing risk analysis, the optimal cutoff point of CRM was 1 mm for local recurrence and 2 mm for distant metastasis. Factors independently associated with local recurrence included CRM ≤1 mm, and high-grade tumor (p = 0.012 and 0.007, respectively). CRM ≤2 mm, as well as pathological, nodal, and overall tumor stage are also significant independent risk factors for distant metastasis (p = 0.025, 0.010, and <0.001, respectively). Conclusion: In this dataset of locally advanced rectal cancer treated with nCRT followed by TME, CRM ≤1 mm is an independent risk factor for local recurrence and is considered a positive margin. CRM ≤2 mm was associated with distant recurrence, independent of pathological tumor and nodal stage. © 2013 Society of Surgical Oncology Reference:.
Keywords: adolescent; adult; cancer survival; aged; middle aged; cancer surgery; survival rate; young adult; major clinical study; cancer recurrence; fluorouracil; advanced cancer; conference paper; cancer radiotherapy; neoadjuvant therapy; cancer staging; nuclear magnetic resonance imaging; follow up; follow-up studies; neoplasm staging; prospective study; prospective studies; adenocarcinoma; neoplasm recurrence, local; risk factors; distant metastasis; adjuvant chemotherapy; cancer size; neoplasm metastasis; rectal neoplasms; rectum cancer; chemoradiotherapy; rectum resection; recurrence free survival
Journal Title: Annals of Surgical Oncology
Volume: 20
Issue: 4
ISSN: 1068-9265
Publisher: Springer  
Date Published: 2013-04-01
Start Page: 1179
End Page: 1184
Language: English
DOI: 10.1245/s10434-012-2722-7
PROVIDER: scopus
PUBMED: 23328971
PMCID: PMC4067458
DOI/URL:
Notes: --- - "Export Date: 1 April 2013" - "CODEN: ASONF" - "Source: Scopus"
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MSK Authors
  1. Philip B Paty
    380 Paty
  2. Karyn A Goodman
    247 Goodman
  3. Mithat Gonen
    727 Gonen
  4. Jose Guillem
    380 Guillem
  5. Jinru Shia
    476 Shia
  6. Martin R Weiser
    351 Weiser
  7. Garrett Nash
    141 Nash
  8. Larissa Temple
    185 Temple