Close distal margin and rectal cancer recurrence after sphincter-preserving rectal resection Journal Article
| Authors: | Nash, G. M.; Weiss, A.; Dasgupta, R.; Gonen, M.; Guillem, J. G.; Wong, D. W. |
| Article Title: | Close distal margin and rectal cancer recurrence after sphincter-preserving rectal resection |
| Abstract: | PURPOSE: Negative surgical margins are important for local control of rectal cancer treated with sphincterpreserving surgery. However, the association of rectal cancer recurrence with close distal margin is not well established. METHODS: Data were extracted from a prospective database of patients collected between 1991 and 2003. Included were 627 patients who underwent curative low anterior resection with total mesorectal excision for rectal cancer 2 to 12 cm from the anal verge. Three hundred ninety-nine patients received neoadjuvant therapy, 65 received postoperative adjuvant therapy alone, and 163 were treated with surgery alone. Median follow-up was 5.8 years. RESULTS: On multivariable analysis, overall recurrence was associated with pathologic stage, lymphovascular invasion, and distal margin. Mucosal recurrence was uncommon; only 16 events were recorded, and of those only 8 were at the initial site of isolated tumor recurrence; 7 of the 8 were surgically salvaged. On univariable analysis, mucosal recurrence was associated with close distal margin (5 vs 2% at 5 y) and lymphovascular invasion (7 vs 2%). Pelvic recurrence, other than isolated mucosal recurrence, was associated with distal location (6 vs 4% at 5 y) and lymphovascular invasion (11 vs 4%). Distal margin as a continuous variable was associated with overall recurrence (excluding isolated mucosal recurrence). CONCLUSIONS: Close distal resection margin identifies patients with increased risk of mucosal and overall cancer recurrence. Although neither causality nor a minimally acceptable margin length can be defined, the data support the importance of achieving a clear distal resection margin in the surgical management of rectal cancer. © The ASCRS 2010. |
| Keywords: | treatment outcome; aged; disease-free survival; middle aged; cancer surgery; retrospective studies; mortality; cancer recurrence; postoperative period; multimodality cancer therapy; adjuvant therapy; disease free survival; combined modality therapy; cancer staging; follow up; neoplasm staging; pelvis; prospective study; cohort studies; neoplasm recurrence, local; cohort analysis; risk factors; recurrence; pathology; retrospective study; risk factor; cancer invasion; lymph vessel; minimal residual disease; neoplasm, residual; tumor recurrence; multivariate analysis; univariate analysis; rectal neoplasms; rectum cancer; rectum tumor; mouth cancer; pelvis cancer; rectum resection; anal canal; distal margin; rectal resection; graft salvage |
| Journal Title: | Diseases of the Colon and Rectum |
| Volume: | 53 |
| Issue: | 10 |
| ISSN: | 0012-3706 |
| Publisher: | Lippincott Williams & Wilkins |
| Date Published: | 2010-10-01 |
| Start Page: | 1365 |
| End Page: | 1373 |
| Language: | English |
| DOI: | 10.1007/DCR.0b013e3181f052d4 |
| PUBMED: | 20847617 |
| PROVIDER: | scopus |
| DOI/URL: | |
| Notes: | --- - "Cited By (since 1996): 1" - "Export Date: 20 April 2011" - "CODEN: DICRA" - "Source: Scopus" |
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