Role of circumferential margin involvement in the local recurrence of rectal cancer

AimThis study aimed to investigate circumferential resection margin (CRM) as a prognostic factor for long‐term oncologic survival after rectal cancer surgery.MethodsPatients diagnosed with malignant rectal cancer between 1 January 2010 and 31 December 2014, from the Surveillance, Epidemiology, and End Results (SEER) program were identified for this study. The patients were divided into five CRM groups to compare the baseline characteristics and assess cancer‐specific survival (CSS): 0‐1 mm, 1.1‐2.0 mm, 2.1‐5.0 mm, 5.1‐10.0 mm, and >10 mm. The main endpoint was CSS.ResultsCircumferential resection margin ≤1 mm was independently associated with 99% increased risk of cancer‐specific mortality in rectal cancer [hazard ratio (HR) = 1.990, 95% confidence interval (CI) = 1.613‐2.454, P < 0.001, using CRM (1.1‐2.0 mm) as a reference]. CRM (5.1‐10.0 mm) was independently associated with 29.2% decreased risk of cancer‐specific mortality [HR = 0.708, 95% CI = 0.525‐0.954, P = 0.152, using group (2.1‐5.0 mm) as reference]. CRM ≤2 mm or ≤0.4 mm was not obviously associated with CSS.Conclusionscircumferential resection margin is an independent prognostic factor in rectal cancer. Surgeons should try to maximize the CRM. Rectal cancer patients with CRM ≤1 mm should receive more postoperative attention depending on individual situation. Also, CRM should be accurately measured in millimeters in a preoperative magnetic resonance imaging or pathological report, rather than simply described as “involved” or “clear.”

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“…This is consistent with most studies on the prognostic prediction of CRM 6, 7, 8, 12, 13, 14, 15, 16…”

Section: Discussionsupporting

confidence: 92%

“…Many studies considered CRM as positive when it was ≤1 mm (R1) and associated with obviously poor prognosis as compared to CRM >1 mm (R0), which was in accordance with the ESMO guidelines 6, 8, 12, 13, 14, 15, 16, 17. The criterion to define a positive CRM remains unclear.…”

Section: Introductionmentioning

confidence: 74%

Circumferential resection margin as a prognostic factor after rectal cancer surgery: A large population‐based retrospective study

et al. 2018

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“…Inadequate surgical resection with lateral tumour spread will result in a local recurrence [9,26]. A distance of more than 1 mm from the tumour to the border of resection is considered to be a negative margin, although a recent analysis reported a distance of 2 mm to be the limit [17].…”

Section: Discussionmentioning

confidence: 99%

TME quality in rectal cancer surgery

et al. 2010

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Background The concept of total mesorectal excision has revolutionised rectal cancer surgery. TME reduces the rate of local recurrence and tumour associated mortality. However, in clinical trials only 50% of the removed rectal tumours have an optimal TME quality. Patients: During a period of 36 months we performed 103 rectal resections. The majority of patients (76%; 78/103) received an anterior resection. The remaining patients underwent either abdominoperineal resection (16%; 17/103), Hartmann's procedure (6%; 6/103) or colectomy (2%; 2/103). Results In 90% (93/103) TME quality control could be performed. 99% (92/93) of resected tumours had optimal TME quality. In 1% (1/93) the mesorectum was nearly complete. None of the removed tumours had an incomplete mesorectum. In 98% (91/93) the circumferential resection margin was negative. Major surgical complications occurred in 17% (18/103). 5% (4/78) of patients with anterior resection had anastomotic leakage. 17% (17/103) developed wound infections. Mortality after elective surgery was 4% (4/95). Conclusion Optimal TME quality results can be achieved in all stages of rectal cancer with a rate of morbidity and mortality comparable to the results from the literature. Future studies should evaluate outcome and local recurrence in accordance to the degree of TME quality.

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“…However, anal preservation may have a higher risk of LR than non‐preservation. In the latter half of the 1900s, total mesorectal excision (TME),3 preoperative chemoradiotherapy (CRT), and optimal circumferential resection margin (CRM) suggested both good control of LR and survival benefit 4, 5. Also, CRT influenced down‐staging of the tumor, and allowed sphincter‐saving operation for some patients who may have required APR 6.…”

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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Role of circumferential margin involvement in the local recurrence of rectal cancer

Cited by 958 publications

References 21 publications

Circumferential resection margin as a prognostic factor after rectal cancer surgery: A large population‐based retrospective study

Circumferential resection margin as a prognostic factor after rectal cancer surgery: A large population‐based retrospective study

TME quality in rectal cancer surgery

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

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