Adequacy of 1-cm Distal Margin After Restorative Rectal Cancer Resection With Sharp Mesorectal Excision and Preoperative Combined-Modality Therapy

Moore, Harvey G.; Riedel, Elyn; Minsky, Bruce D.; Saltz, Leonard; Paty, Philip B.; Wong, Douglas; Cohen, Alfred M.; Guillem, José G.

doi:10.1245/aso.2003.04.010

Cited by 201 publications

(118 citation statements)

References 19 publications

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“…Tumor regression has been found to correlate positively with increased survival [11,12,13,14,15,16,17,18,19,20]. Our complete pathologic response rate of 21% following neoadjuvant chemoradiotherapy is comparable to those reported in the recent literature [21,22,23,24].…”

Section: Discussionsupporting

confidence: 84%

“…Over the past few years, with increased utilization of preoperative chemotherapy and radiation therapy followed by radical resection, some authors have suggested that distal resection margins of <2 cm may be adequate [14,15,16,17]. The purpose of this study was to review our institutional experience with rectal cancers treated with neo-adjuvant chemoradiation therapy (CRT), followed by radical proctectomy with total mesorectal excision (TME), and analyze the impact of distal resection margin length on outcomes.…”

Section: Introductionmentioning

confidence: 99%

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Distal Margins in Radical Resections for Rectal Cancer after Chemoradiation Therapy: How Short Is Long Enough?

2010

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Background: The purpose of our study was to assess the impact of distal margin length on outcome in patients with rectal cancer treated with neoadjuvant chemoradiation therapy (CRT) followed by radical resection. Methods: Fifty-three consecutive patients were evaluated. The selection criteria included: adenocarcinoma of the mid- or distal rectum, locally advanced stage, absence of distant metastases, and preoperative CRT followed by proctectomy with total mesorectal excision. The operations included low anterior resection in 33 patients (62%) and abdominoperineal resection in 20 (38%). The outcome measures were: tumor regression, complete pathologic response, length of distal resection margins, status of radial margins and recurrence rate. Results: Forty-eight patients (91%) had tumor regression, and 11 (21%) had a complete pathologic response. Distal resection margins were tumor-free in all patients, ranging in length from 0.1 to 7.4 cm (mean = 2.2). Follow-up (mean = 48.8 months) was current in 50 of 53 patients (94%). There was no locoregional recurrence. Conclusions: Distal resection margins shorter than 1–2 cm appear to be equivalent to longer margins in patients who undergo CRT followed by proctectomy with total mesorectal excision. These findings may lead to greater utilization of sphincter-saving procedures in rectal cancer.

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Section: Discussionsupporting

confidence: 84%

Section: Introductionmentioning

confidence: 99%

Distal Margins in Radical Resections for Rectal Cancer after Chemoradiation Therapy: How Short Is Long Enough?

2010

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“…In the 21st century, better understanding of the distal spread based on the pathological studies justified reduction of the DRM from 20 mm to 10 mm 7, 8. Neoadjuvant CRT enabled the DRM to be decreased to 5–10 mm 9, 10, 11. A DRM of 10 mm is thought to be safe and reasonable for anal preservation when ISR is applied for a very low rectal cancer closer to the anus 12…”

Section: Discussionmentioning

confidence: 99%

“…Also, CRT influenced down‐staging of the tumor, and allowed sphincter‐saving operation for some patients who may have required APR 6. In addition to those aspects, shorter distal resection margin proposed by clinicopathological studies has encouraged surgeons to preserve the anus 7, 8, 9, 10, 11, 12, 13. In 1994, Schiessel et al .…”

Section: Introductionmentioning

confidence: 99%

Intersphincteric resection for very low rectal cancer: A review of the updated literature

Shirouzu

Murakami

Akagi

2017

Annals of Gastroent Surgery

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Intersphincteric resection (ISR) has rapidly increased worldwide including laparoscopic surgery. However, there are some concerns for the definition of ISR, surgical technique, oncological outcome, anal function, and quality of life (QoL). The aim of the present study is to evaluate those issues. A review of this surgical technique was carried out by searching English language literature of the PubMed online database and appropriate articles were identified. With regard to open‐ISR, the morbidity rate ranged from 7.5% to 38.3%, with lower mortality rates. Local recurrence rates varied widely from 0% to 22.7%, with a mean follow‐up duration of 40–94 months. Disease‐free and overall 5‐year survival rates were 68–86% and 76–97%, respectively. Those outcomes were equivalent to laparoscopic‐ISR. Surgical and oncological outcomes of ISR were generally acceptable. However, accurate evaluation of anal function and QoL was difficult because of a lack of standard assessment of various patient‐related factors. The surgical and oncological outcomes after ISR seem to be acceptable. The ISR technique seems to be valid as an alternative to abdominoperineal resection in selected patients with a very low rectal cancer. However, both necessity for ISR and expectations of QoL impairment as a result of functional disorder should be fully discussed with patients before surgery.

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“…Initially, 5-cm distal margins were considered necessary [14], but data later confirmed that smaller distal margins were not associated with worse oncologic outcomes [15,16]. Margins of less than 1 cm may be acceptable following neoadjuvant chemoradiation therapy in an attempt to preserve the anal sphincter [17,18]. A total mesorectal excision is important and generally provides an adequate circumferential margin (usually greater than 1-2 mm from resected margin to tumor) [19].…”

Section: Rectal Adenocarcinoma Versus Rectal/pelvic Leiomyosarcomamentioning

confidence: 99%

Tumor Biological Aspects of Epithelial versus Mesenchymal Tumors of the Gastrointestinal Tract

Raut

2018

Visc Med

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One of the holy grails of cancer surgery for surgical oncologists is to perform a macroscopically complete resection of the affected organ or site with negative microscopic margins. The surgical oncologist must also be mindful of what constitutes appropriately-sized negative margins. However, what is necessary, based on the best available evidence, can vary considerably for different malignancies arising within the same organ. This review compares two different gastric and rectal malignancies, one each of epithelial and of mesenchymal origin. Data supporting extent of margins will be reviewed, illustrating the importance of knowing the histologic diagnosis prior to surgery to provide proper oncologic care.

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Adequacy of 1-cm Distal Margin After Restorative Rectal Cancer Resection With Sharp Mesorectal Excision and Preoperative Combined-Modality Therapy

Abstract: Our data suggest that for patients with locally advanced rectal cancer undergoing resection and preoperative CMT, distal margins < or = 1 cm do not seem to compromise oncological outcome.

Cited by 201 publications

References 19 publications

Distal Margins in Radical Resections for Rectal Cancer after Chemoradiation Therapy: How Short Is Long Enough?

Distal Margins in Radical Resections for Rectal Cancer after Chemoradiation Therapy: How Short Is Long Enough?

Intersphincteric resection for very low rectal cancer: A review of the updated literature

Tumor Biological Aspects of Epithelial versus Mesenchymal Tumors of the Gastrointestinal Tract

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