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

Abstract

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.

Discussion of QOL (with Concise Summary of Newer Clinical Research) in Colorectal Cancer Patients Treated in a Retrospective Trial on the Effect of Surgical Resection Margins on Survival, with Relation to Operation Type

“…The distal resection margin was, not shown to be an independent predictor of survival. Again, consistent with other literature (12,14,20). Thus, a distal magin of less than 1 cm may be acceptable, if the tumour was completely removed.…”

“…The negative distal resection margin (DRM) is broadly de ned as a distance from the distal border of the tumour (12). As such, its effect on local reccurence and survival is still somewhat controversial, with contradicting studies (9,12,13). Newer litarature contends, that even a safety margin of less than 1 cm is enough to ensure su cient radicality, especially in TNM stage 1 and stage 2 lesions -which are commonly intercepted by screening programs.…”

Validation of the Slovenian version of the low anterior resection syndrome score for rectal cancer patients after surgery

“…Rectal carcinoma is one of the most common forms of cancer in both men and women in the Western world and one of the most common causes of death (1, 2, 3). The substantial improvement in rectal cancer survival rates is the result of earlier diagnosis, advances in surgical techniques and improved delivery of radiotherapy.…”

“…The substantial improvement in rectal cancer survival rates is the result of earlier diagnosis, advances in surgical techniques and improved delivery of radiotherapy. Sphincter-preserving low anterior resection (LAR) with total or partial mesorectal excision has become the gold standard treatment for mid and low rectal cancers (3). Many patients who undergo a LAR for rectal cancer suffer major defecation dysfunction due to nerve and sphincter damage combined with poor neorectal capacity (4).…”

Key clinical applications for indocyanine green fluorescence imaging in minimally invasive colorectal surgery

“…Dissection must be precise (along the embryological avascular areolar plane, between the mesorectal fascia propria and the fascia of the pelvic sidewall) and done in a sharp, not blunt, manner. [ 29 30 ]…”