The adequacy of the distal resection margin after preoperative chemoradiotherapy for rectal cancer

Kim, T. G.; Park, W.; Choi, Doo Ho; Kim, S.-H.; Kim, H. C.; Lee, W. Y.; Park, J. O.; Park, Y. S.

doi:10.1111/codi.12554

Cited by 7 publications

(7 citation statements)

References 22 publications

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“…We found that pathologic TRG > 3 had worse DFS when margins were less than 1 cm (HR, 4.4; p = −0.02). Similar findings were noted by Kim et al for margins < 3 mm when tumor response to CRT was inadequate 25 . This is likely because of nonhomogenous regression patterns to CRT specifically in nonresponders allowing scattered islands of viable tumor cells distant from the margins 26 .…”

Section: Discussionsupporting

confidence: 81%

“…Pathologic T3/T4 tumors had worse pelvic control rates when DRM was less than 3 mm. 25 Although the hazard ratio for recurrences was higher in T3/T4 tumors in our patients (HR, 1.8), it did not reach statistical significance (p = 0.16).…”

Section: Resultscontrasting

confidence: 73%

“…Kim et al compared 3 mm or less distal margins in rectal cancers treated with preoperative CRT versus those that had more than 3 mm margins. Pathologic T3/T4 tumors had worse pelvic control rates when DRM was less than 3 mm 25 . Although the hazard ratio for recurrences was higher in T3/T4 tumors in our patients (HR, 1.8), it did not reach statistical significance ( p = 0.16).…”

Section: Discussioncontrasting

confidence: 76%

“…Similar findings were noted by Kim et al for margins < 3 mm when tumor response to CRT was inadequate. 25 This is likely because of nonhomogenous regression patterns to CRT specifically in nonresponders allowing scattered islands of viable tumor cells distant from the margins. 26 The probable hypothesis for poorer local control in inadequately responding tumors with smaller DRM is likely the same.…”

Section: Resultsmentioning

confidence: 99%

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Long‐term oncological outcomes of the sphincter preserving total mesorectal excision with varying distal resection margins

Kazi

Bhamre

Desouza

et al. 2021

Journal of Surgical Oncology

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Introduction: A subcentimeter distal resection margin (DRM) appears to be acceptable for most patients, however, long-term follow up and specific subsets where DRM would influence recurrences have not been adequately investigated. Methods: A retrospective analysis of all sphincter-preserving resections for mid and low rectal cancers between July 2011 and May 2015 was performed. Extended total mesorectal excisions (TME) and patients with positive pathologic circumferential margins (CRM) were excluded. Results: Two hundred and thirty-six patients fit the inclusion criteria. DRM > 20 mm was obtained in 117 patients (49.6%), between 10 and 20 mm in 78 (33%) and <10 mm in 41 (17.4%) patients. Pathological DRM was positive in 4 patients (1.7%).Sixty-five recurrences occurred at a median follow up of 78.5 months. DRM did not influence any of the oncological outcomes. In a subset analysis of patients with poor pathological response to neoadjuvant radiation, that is, tumor regression grade > 3, DRM influenced disease-free survival (DFS) but not overall survival with a hazard ratio of 4.4 (p = 0.02). This was confirmed on multivariate regression analysis in this subgroup as well where pathological nodal status and DRM < 10 mm were independent predictors of DFS.Conclusions: A subcentimeter DRM may be acceptable in most patients except those who have an inadequate response to neoadjuvant radiation.With growing enthusiasm for sphincter preservation, many studies have demonstrated that a reduction in the distal resection margin (DRM) allows acceptable oncological outcomes after total mesorectal excision (TME) for rectal cancers. Much has been studied about the length of adequate DRM and we have evolved from historical 5 cm margins to 2 cm 1 and a DRM of less than 1 cm is also currently acceptable after neoadjuvant chemoradiation (CRT). 2 The length of the distal margin depends on the distal intramural spread of

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Section: Discussionsupporting

confidence: 81%

Section: Resultscontrasting

confidence: 73%

Section: Discussioncontrasting

confidence: 76%

Section: Resultsmentioning

confidence: 99%

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Long‐term oncological outcomes of the sphincter preserving total mesorectal excision with varying distal resection margins

Kazi

Bhamre

Desouza

et al. 2021

Journal of Surgical Oncology

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“…However, there are studies which still question the credibility of subcentimeter DRM. This is because of a variable response to NACRT and the inferior results seen in the non-responders [20,21].…”

Section: Introductionmentioning

confidence: 99%

Impact of Length of Distal Margin on Outcomes Following Sphincter Preserving Surgery for Middle and Lower Third Rectal Cancers

Bhamre

Mitra

Tamankar

et al. 2019

Indian J Surg Oncol

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Outcomes of sphincter preserving surgery for distal rectal cancers improve with clear circumferential resection and distal resection margin. However, the extent of distal resection margin after a complete mesorectal excision is often a cause for debate. We evaluated the outcome of middle and lower third rectal cancer patients undergoing sphincter preservation with variable distal resection margin at our center. Patients with biopsy-proven rectal adenocarcinoma within 10 cm from anal verge undergoing sphincter preserving resections were included. Patients with positive circumferential resection margin were excluded. Patients were divided into three groups based on the extent of distal resection margin (< 6 mm, 6-10 mm, > 10 mm) and oncological outcomes were compared. The median age of 242 patients was 50 years and 44 (18.2%) were high-grade tumors. Preoperative chemoradiation was used in 185 (75.2%) patients. Median distal resection margin was 20 mm. Patients in < 10 mm group had a significantly higher proportion of lower third (68.3% vs 39.8%, p = 0.004) and chemoradiation-treated tumors (85.4 vs 74.6%, p = 0.001). A significantly higher percentage required an intersphincteric resection in the < 10 mm group (53.7% vs 14.4%, p = 0.0001). Significantly higher percentage tumors were pT3 in > 10 mm group (45.3% vs. 31.7%) (p = 0.05). The median follow-up was 23 months. There was no difference in the overall, loco-regional, and distant recurrence rates between the three groups. A subcentimeter distal resection margin does not influence loco-regional or distant recurrence rates following sphincter preserving surgery for middle and lower third rectal adenocarcinoma.

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Robotic Abdominoperineal Resection

Bednarski¹,

Chang²

2014

Surgery for Cancers of the Gastrointestinal Tract

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The adequacy of the distal resection margin after preoperative chemoradiotherapy for rectal cancer

Abstract: The results suggest that a distal margin of < 3 mm in the surgical specimen after preoperative CRT is associated with a lower rate of pelvic tumour control at 5 years in patients with Stage ypT3-4 tumours or in those who do not respond to CRT.

Cited by 7 publications

References 22 publications

Long‐term oncological outcomes of the sphincter preserving total mesorectal excision with varying distal resection margins

Long‐term oncological outcomes of the sphincter preserving total mesorectal excision with varying distal resection margins

Impact of Length of Distal Margin on Outcomes Following Sphincter Preserving Surgery for Middle and Lower Third Rectal Cancers

Robotic Abdominoperineal Resection

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