Distal Intramural Spread Is an Independent Prognostic Factor for Distant Metastasis and Poor Outcome in Patients With Rectal Cancer: A Multivariate Analysis

Nakagoe, Tohru; Yamaguchi, Eiichiro; Tanaka, Kenji; Sawai, Terumitsu; Tsuji, Takashi; Shibasaki, Susumu; Nanashima, Atsushi; Yamaguchi, Hiroyuki; Yasutake, Toru; Ayabe, Hiroyoshi

doi:10.1245/aso.2003.05.027

Cited by 36 publications

(29 citation statements)

References 17 publications

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“…Rarely does it extend for more than 2 cm in nonirradiated tumours. When it does, it is associated with advanced disease and poor long- term prognosis even when all resection margins are free of disease 12 , 13 . Similarly, not often does DIS extend more than 1 cm from the distal edge of the gross tumour in rectal cancer patients treated with preoperative CRT.…”

Section: Introductionmentioning

confidence: 99%

The influence of the distal resection margin length on local recurrence and long- term survival in patients with rectal cancer after chemoradiotherapy and sphincter- preserving rectal resection

Grosek

Velenik

Edhemović

et al. 2016

Radiology and Oncology

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BackgroundLow recurrence rates and long term survival are the main therapeutic goals of rectal cancer surgery. Complete, margin- negative resection confers the greatest chance for a cure. The aim of our study was to determine whether the length of the distal resection margin was associated with local recurrence rate and long- term survival.Patients and methodsOne hundred and nine patients, who underwent sphincter-preserving resection for locally advanced rectal cancer after preoperative chemoradiotherapy between 2006 and 2010 in two tertiary referral centres were included in the study. Distal resection margin lengths were measured on formalin-fixed, pinned specimens. Characteristics of patients with distal resection margin < 8 mm (Group I, n = 27), 8–20 mm (Group II, n = 31) and > 20 mm (Group III, n = 51) were retrospectively analysed and compared. Median (range) follow-up time in Group I was 89 (51–111), in Group II 83 (57–111) and in Group III 80 (45–116) months (p = 0.326), respectively.ResultsUnivariate survival analysis showed that distal resection margin length was not statistically significantly associated with overall survival or local recurrence rate (p > 0.05). In a multiple Cox regression analysis, after adjusting for pathologic T and N stage (yT, yN), distal resection margin length was still not statistically significantly associated with overall survival.ConclusionsOur study shows that close distal resection margins can be accepted as oncologically safe for sphincter-preserving rectal resections after preoperative chemoradiotherapy.

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Section: Introductionmentioning

confidence: 99%

The influence of the distal resection margin length on local recurrence and long- term survival in patients with rectal cancer after chemoradiotherapy and sphincter- preserving rectal resection

Grosek

Velenik

Edhemović

et al. 2016

Radiology and Oncology

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“…Therefore, we presumed that tumors with limited circumferential extent increased the probability of pCR and affected local recurrence. In addition, distal intramuralspreadisthedistalextensionofviabletumorcellsinto thebowelwallbeneaththemucosaledge,andhasbeenassociated with distant metastasis and DFS [15]. Intramural spread is significantly less in preoperative CRT, compared with primary surgery [16].…”

Section: Discussionmentioning

confidence: 99%

Which Patients Benefit from Preoperative Chemoradiotherapy for Intermediate Staged Rectal Cancer?

et al. 2011

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Background: The aim of this study was to identify subgroups that benefit from preoperative or postoperative chemoradiotherapy (CRT) for rectal cancer of intermediate stage. Patients and Methods: Between 1999 and 2004, 118 and 177 patients matched with respect to clinical T stage, circumferential tumor extent (= 60% / > 60%), lymph node metastasis, and lymph node size (< 1 cm / = 1 cm), were allocated to preoperative CRT and postoperative CRT, respectively. In preoperative CRT, a total of 45 Gy was delivered with chemotherapy, and then surgery followed. In postoperative CRT, 45–51 Gy was delivered with chemotherapy following primary surgery. Results: Local recurrence, distant metastasis, disease-free survival, and disease-specific survival were not different between the two schemes. For a circumferential tumor extent of = 60%, local recurrence in preoperative CRT (3.6%) was lower than in postoperative CRT (11.9%) (p = 0.084, hazard ratio (HR) = 0.274, 95% confidence interval (CI) = 0.058–1.032). For a tumor located < 5cm from the anal verge, distant metastasis in preoperative CRT (18.9%) was lower than in postoperative CRT (34.4%) (p = 0.061, HR = 0.444, 95% CI = 0.188– 1.047), and 5-year disease-free survival rates in preoperative and postoperative CRT were 72.0 and 59.0%, respectively (p = 0.078). Conclusions: Our findings suggest that preoperative CRT might be appropriate in rectal cancer involving the limited circumferential lumen and located in the low rectum. However, further prospective studies are required.

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“…Patients with T4 tumors [37] or N+ tumors [32,33] who have not undergone neo-adjuvant CRT [31,37] have a risk of intramural invasion extending beyond 1 cm in 4-7% of cases but the risk of extension beyond 2 cm is close to 0% [31,33,37]. Conversely, in the absence of these criteria, there is no risk of tumor extension beyond 1 cm [33,34,37] and the rates of local recurrence [34,35] and RFS [34] are similar among patients with a distal margin of more or less than one cm [34,35]. The rate of invasion of distal margins by locally advanced tumors that responds poorly or not at all to neo-adjuvant CRT is unknown.…”

Section: Distal Resection Marginmentioning

confidence: 99%

“…The rate of invasion of distal margins by locally advanced tumors that responds poorly or not at all to neo-adjuvant CRT is unknown. The distal margin should be measured in vivo or immediately after resection with the specimen pinned to a board [31,33,37] because formalin fixation induces tissue retraction, diminishing the measured margin by half [38].…”

Section: Distal Resection Marginmentioning

confidence: 99%

Surgical strategy for low rectal cancers

Dumont

Mariani

Élias

et al. 2015

Journal of Visceral Surgery

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The two goals of surgery for lower rectal cancer surgery are to obtain clear "curative" margins and to limit post-surgical functional disorders. The question of whether or not to preserve the anal sphincter lies at the center of the therapeutic choice. Histologically, tumor-free distal and circumferential margins of>1mm allow a favorable oncologic outcome. Whether such margins can be obtained depends of TNM staging, tumor location, response to chemoradiotherapy and type of surgical procedure. The technique of intersphincteric resection relies on these narrow margins to spare the sphincter. This procedure provides satisfactory oncologic outcome with a rate of circumferential margin involvement ranging from 5% to 11%, while good continence is maintained in half of the patients. The extralevator abdominoperineal resection provides good oncologic results, however this procedure requires a permanent colostomy. A permanent colostomy alters several domains of quality of life when located at the classical abdominal site but not when brought out at the perineal site as a perineal colostomy.

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Distal Intramural Spread Is an Independent Prognostic Factor for Distant Metastasis and Poor Outcome in Patients With Rectal Cancer: A Multivariate Analysis

Abstract: Distal intramural spread is an independent risk factor for distant metastasis and poor prognosis in patients with rectal cancer.

Cited by 36 publications

References 17 publications

The influence of the distal resection margin length on local recurrence and long- term survival in patients with rectal cancer after chemoradiotherapy and sphincter- preserving rectal resection

The influence of the distal resection margin length on local recurrence and long- term survival in patients with rectal cancer after chemoradiotherapy and sphincter- preserving rectal resection

Which Patients Benefit from Preoperative Chemoradiotherapy for Intermediate Staged Rectal Cancer?

Surgical strategy for low rectal cancers

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