Extent of mesorectal spread and involvement of lateral resection margin as prognostic factors after surgery for rectal cancer

Cawthorn, S.; Caffarey, S. M.; Broughton, C. I. M.; Marks, C. G.; Chir, M.; Parums, Dinah V.; Gibbs, N. M.; A’Hern, Roger

doi:10.1016/0140-6736(90)92631-q

Cited by 317 publications

(180 citation statements)

References 24 publications

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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%

“…First, the SEER database lacked the data on local recurrence, which is an important factor that influences the survival of rectal cancer. However, patients with an R1 CRM often die from metastatic disease before local recurrence 7, 36. In addition, definitions of local recurrence were different in previous studies, making it difficult to examine the prognosis of different CRMs.…”

Section: Discussionmentioning

confidence: 99%

“…While several studies showed that CRM should not be used as a prognostic factor in rectal cancer,4, 5 other studies demonstrated the importance of CRM as an independent prognostic factor of local recurrence and long‐term survival,6, 7, 8, 9 including the first report by Quirke et al10 suggesting that CRM might be a strong predictor of long‐term oncologic outcomes. According to the European Society for Medical Oncology (ESMO) Clinical Practice Guidelines for rectal cancer, CRM is defined as involved if it is ≤1 mm from the tumor‐free margin, leading to an increased risk of local recurrence, distant metastases, and poorer survival 11…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2018

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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%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

et al. 2018

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“….Features on histological examination of resected specimens predict increased risk of postoperative systemic recurrence including more than 5mm invasion of disease through the muscularis into the mesorectum (≥T3c) [24,25], extra-mural vascular invasion (EMVI) [26] and lymph node involvement (LN+) [27]. For patients with such features, with optimum surgery and selective use of pre-operative radiotherapy, DM relapse is Gollins approximately 6-fold greater than LR (approximately 30% vs. 5%) [6,7,28] and is now the main cause of death.…”

Section: Introductionmentioning

confidence: 99%

Neoadjuvant Treatment Strategies for Locally Advanced Rectal Cancer

Gollins

Sebag‐Montefiore

2016

Clinical Oncology

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Improved surgical technique plus selective pre-operative radiotherapy, has decreased rectal cancer pelvic local recurrence (LR) from historically 25%, down to approximately 5-10%. However, this improvement has not reduced distant metastatic relapse, the main cause of death and a key issue in rectal cancer management.The current standard is local pelvic treatment (surgery +/-pre-operative radiotherapy) followed by adjuvant chemotherapy (AC), depending on resection histology. For circumferential resection margin (CRM)-threatened cancer on baseline MRI, downstaging long-course pre-operative chemoradiation (LCPCRT) is generally used. However, for non-CRM threatened disease, varying approaches are currently adopted in the UK, including straight to surgery (STS), short-course pre-operative radiotherapy (SCPRT) and LCPCRT.Clinical trials are investigating intensification of concurrent chemoradiation. There is also increasing interest in investigating pre-operative neoadjuvant chemotherapy (NAC) as a way of exposing micro-metastatic disease to full dose systemic chemotherapy as early as possible and potentially reducing metastatic relapse.Phase II trials suggest that this strategy is feasible, with promising histological response and low rates of tumour progression during NAC. Phase III trials are needed to determine the benefit of NAC when added to standard therapy and also to determine if it can be used instead of neoadjuvant radiotherapy based schedules.

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“…Tumor depth, namely T stage, is important as T1 and T2 tumors have excellent long time survival, whereas T3 tumors, which make up 80% of rectal tumors seen in clinical practice (55) and T4 have more variable prognoses, thus, the newest edition of the TNM classification suggests an optional expansion of classifying extramural spread (9,55,56).…”

Section: Prognostic Factors and Response Evaluationmentioning

confidence: 99%

Inhibitory effects of oxaliplatin in experimental radiation treatment of colorectal carcinoma: does oxaliplatin improve 5-fluorouracil-dependent radiosensitivity?

Folkvord

Flatmark

Seierstad

et al. 2008

Radiotherapy and Oncology

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Extent of mesorectal spread and involvement of lateral resection margin as prognostic factors after surgery for rectal cancer

Cited by 317 publications

References 24 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

Neoadjuvant Treatment Strategies for Locally Advanced Rectal Cancer

Inhibitory effects of oxaliplatin in experimental radiation treatment of colorectal carcinoma: does oxaliplatin improve 5-fluorouracil-dependent radiosensitivity?

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