Circumferential Resection Margin is Associated With Distant Metastasis After Rectal Cancer Surgery

Abstract

Objective: To evaluate circumferential resection margin (CRM) as a risk factor for distant metastasis (DM) in rectal cancer. Summary of Background Data: The treatment of rectal cancer has evolved over the last decades. Surgical radicality is considered the most important factor in preventing recurrences including local and distant. CRM ≤1.0 mm is considered to increase recurrence risk. This study explores the risk of DM in relation to exact CRM. Methods: All patients treated with abdominal resection surgery for rectal cancer between 2005 and 2013 in Sweden were eligible for inclusion in this retrospective study. Primary endpoint was DM.Results: Twelve thousand one hundred forty-six cases were identified. Eight thousand five hundred ninety-three cases were analyzed after exclusion. Seven hundred seventeen (8.6%) patients had CRM ≤1.0mm and 7577 (91.4%) patients had CRM >1.0 mm. DM recurrence rate at 5 years was 42.1% (95% CI 32.5-50.3), 31.5% (95% CI 27.3-35.5), 25.8% (95% Confidence Interval (CI) 16.2-34.4), and 19.5% (95% CI 18.5-19.5) when CRM was 0.0 mm, 0.1 to 1.0 mm, 1.1 to 1.9 mm, and CRM ≥2mm, respectively. Multivariable analysis revealed higher DM risk in CRM 0.0-1.0 mm versus >1.0 mm (hazard ratio 1.30, 95% CI 1.05-1.60; P = 0.015). No significant difference in DM risk in CRM 1.1-1.9 mm versus ≥2.0 mm (hazard ratio 0.66, 95% CI 0.34-1.28; P = 0.224) could be detected. Conclusions: The risk of DM decreases with increasing CRM. Moreover, CRM ≤1.0 mm is a significant risk factor for DM. Thus, CRM is a dominant factor when discussing risk of DM after rectal cancer surgery.

Clinical feasibility of the therapeutic strategies total neoadjuvant therapy and “watch and wait” in the treatment of rectal cancer patients with recurrence after clinical complete response

“…This study used this standard for CRM positivity. Some researchers believe that positive CRM is a risk factor for local recurrence and that the distance between the tumor and MRF is negatively correlated with the prognosis ( 12 , 27 ). A study on neoadjuvant therapy shows that even if patients with positive CRM undergo surgical resection of the lesion after neoadjuvant therapy, positive CRM is still a risk factor for local recurrence ( 28 ).…”

Pathologic Implications of Radial Resection Margin and Perineural Invasion to Adjuvant Chemotherapy after Preoperative Chemoradiotherapy and Surgery for Rectal Cancer: A Multi-Institutional and Case-Matched Control Study

“…We explored the implications of pathologic features to identify the subgroup of patients with rectal cancer indicated for adjuvant chemotherapy. Surgical margin has been a well-known prognostic factor before neoadjuvant CRT era [ 3 , 24 , 25 , 26 , 27 ]. Quirke et al first reported that positive surgical margin increased local recurrence in 1986 [ 25 ].…”

“…Thus, we investigated patients who benefited from adjuvant chemotherapy based on pathologic factors. Surgical margin and perineural invasion are well-known prognostic features in rectal cancer [ 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 ]. We investigated the role of adjuvant chemotherapy in patients with rectal cancer who received neoadjuvant CRT and curative TME in this multi-institutional study, according to the status of surgical margin and perineural invasion.…”

Reporting of Circumferential Resection Margin in Rectal Cancer Surgery

“…A positive CRM is associated with an increased risk for local recurrence and distant metastasis and worse overall survival rates . Although there has been some debate about what constitutes a negative CRM, the commonly accepted margin of 1 mm from the tumor is considered a negative resection …”

“…8,9 Although there has been some debate about what constitutes a negative CRM, the commonly accepted margin of 1 mm from the tumor is considered a negative resection. 10 To study and improve health care delivery and quality, valid quality measures must be identified and broadly reported. Strong quality measures are those for which compliance translates into improved patient outcomes.…”