Sparing Sphincters and Laparoscopic Resection Improve Survival by Optimizing the Circumferential Resection Margin in Rectal Cancer Patients

Abstract

The goal of rectal cancer treatment is to minimize the local recurrence rate and extend the disease-free survival period and survival. For this aim, obtainment of negative circumferential radial margin (CRM) plays an important role. This study evaluated predictive factors for positive CRM status and its effect on patient survival in mid- and distal rectal tumors.Patients who underwent curative resection for rectal cancer were included. The main factors were demographic data, tumor location, surgical technique, neoadjuvant therapy, tumor diameter, tumor depth, lymph node metastasis, mesorectal integrity, CRM, the rate of local recurrence, distant metastasis, and overall and disease-free survival. Statistical analyses were performed by using the Chi-squared test, Fisher exact test, Student t test, Mann–Whitney U test and the Mantel–Cox log-rank sum test.A total of 420 patients were included, 232 (55%) of whom were male. We observed no significant differences in patient characteristics or surgical treatment between the patients who had positive CRM and who had negative CRM, but a higher positive CRM rate was observed in patients undergone abdominoperineal resection (APR) (P < 0.001). Advanced T-stage (P < 0.001), lymph node invasion (P = 0.001) and incomplete mesorectum (P = 0.007) were encountered significantly more often in patients with positive CRM status. Logistic regression analysis revealed that APR (P < 0.001) and open resection (P = 0.046) were independent predictors of positive CRM status. Moreover, positive CRM was associated with decreased 5-year overall and disease-free survival (P = 0.002 and P = 0.004, respectively).This large single-institution series demonstrated that APR and open resection were independent predictive factors for positive CRM status in rectal cancer. Positive CRM independently decreased the 5-year overall and disease-free survival rates.

Dose–time fractionation schedules of preoperative radiotherapy and timing to surgery for rectal cancer

“…Nevertheless, it significantly improved survival in patients with a pCR, downstaging, or a negative circumferential margin. 110,111,144,145…”

“…Nevertheless, it significantly improved survival in patients with a pCR, downstaging, or a negative circumferential margin. 110,111,144,145 Early systematic reviews concluded that preoperative RT at a BED of >30 Gy reduced LR risk and improved OS, 25,146 and that no significant difference was observed in outcomes for different time intervals between conventional neoadjuvant CRT and surgery. 147 Moreover, higher doses increased LR reduction.…”

Prognostic importance of circumferential resection margin in the era of evolving surgical and multidisciplinary treatment of rectal cancer: A systematic review and meta-analysis

“…Analyses for CRMþ rates based on the definition of 1 mm was performed for the predefined subgroups (Appendix Table 3). The pooled proportion of CRM involvement was significantly lower for restorative procedures (17 which was significantly higher than the pooled 9.0% for the studies in which the majority of the rectal cancer patients were operated upon after 2005 (n ¼ 12 studies; 9,486 patients) 47,53,56,57,66,70,71,75,76,82,88,90 (P ¼ .050).…”