Factors associated with anastomotic recurrence after total mesorectal excision in rectal cancer patients

Kim, Young Wan; Kim, Nam Kyu; Min, Byung Soh; Huh, Hyuk; Kim, Jin-Soo; Kim, Jeong Yeon; Sohn, Seung Kook; Cho, Chang Hwan

doi:10.1002/jso.21166

Cited by 58 publications

(57 citation statements)

References 27 publications

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“…However, in clinical practice, it happens rarely, in approximately in 2% of patients in the subgroups with B1 cm distal bowel margin. 9,20,21,34 In conclusion, our findings support the practice of sphincter preservation in selected settings of close distal margins (\1 cm) after total mesorectal excision for distal rectal cancer. Our review could not find a statistically significant difference in either local control or survival with margins of \1 cm.…”

Section: Discussionsupporting

confidence: 74%

“…The remaining 17 studies constituted the material for the current review. [7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23] Only one report prospectively explored the issue in question as the secondary end point. 20 The remaining reports were retrospective.…”

Section: Resultsmentioning

confidence: 99%

“…In the remaining 15 studies the difference in local recurrence rate between the short margin group and to the long margin group was not significant in univariate analysis. [7][8][9][10][11][12][13][15][16][17][19][20][21][22][23] Of the eight reports showing long-term survival, survival did not differ statistically between the two groups in seven; in one remaining study survival was lower in the short margin group compared to the long margin group ( Table 1).…”

Section: Outcomes In Relation To Distal Bowel Margin Shorter or Longementioning

confidence: 99%

“…Four remaining series showed no association between the length of bowel clearance and anastomotic recurrence. 9,11,15,21 This was confirmed by multivariable analysis carried out in the largest series reported by Kim et al 21 The results of the meta-analysis methodology used to evaluate all of the above reports showed that the estimated overall anastomotic recurrence rate was 1.6% higher in the \1-cm margin group compared to the [1-cm margin group (95% CI -0.8 to 4.1) but this was not statistically significant (P = 0.221); test for heterogeneity, P = 0.97.…”

Section: Anastomotic Recurrences In Relation To Distal Bowel Margin Smentioning

confidence: 99%

See 3 more Smart Citations

Is the 1-cm Rule of Distal Bowel Resection Margin in Rectal Cancer Based on Clinical Evidence? A Systematic Review

Bujko

Rutkowski

Chang

et al. 2012

Indian J Surg Oncol

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Background. Distal intramural spread is present within 1 cm from visible tumor in a substantial proportion of patients. Therefore, C1 cm of distal bowel clearance is recommended as minimally acceptable. However, clinical results are contradictory in answering the question of whether this rule is valid. The aim of this review was to evaluate whether in patients undergoing anterior resection, a distal bowel gross margin of \1 cm jeopardizes oncologic safety. Methods. A systematic review of the literature identified 17 studies showing results in relation to margins of approximately \1 cm (948 patients) versus [1 cm (4626 patients); five studies in relation to a margin of B5 mm (173 patients) versus [5 mm (1277 patients), and five studies showing results in a margin of B2 mm (73 patients). In most studies, pre-or postoperative radiation was provided. Results. A multifactorial process was identified resulting in selection of favorable tumors for anterior resection with the short bowel margin and unfavorable tumors for abdominoperineal resection or for anterior resection with the long margin. In total, the local recurrence rate was 1.0% higher in the \1-cm margin group compared to the [1-cm margin group (95% confidence interval [CI] -0.6 to 2.7; P = 0.175). The corresponding figures for B5 mm cutoff point were 1.7% (95% CI -1.9 to 5.3; P = 0.375). The pooled local recurrence rate in patients having B2 mm margin was 2.7% (95% CI 0 to 6.4). Conclusions. In the selected group of patients, \1 cm margin did not jeopardize oncologic safety.

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Section: Discussionsupporting

confidence: 74%

Section: Resultsmentioning

confidence: 99%

Section: Outcomes In Relation To Distal Bowel Margin Shorter or Longementioning

confidence: 99%

Section: Anastomotic Recurrences In Relation To Distal Bowel Margin Smentioning

confidence: 99%

See 2 more Smart Citations

Is the 1-cm Rule of Distal Bowel Resection Margin in Rectal Cancer Based on Clinical Evidence? A Systematic Review

Bujko

Rutkowski

Chang

et al. 2012

Indian J Surg Oncol

View full text Add to dashboard Cite

show abstract

“…Factors as tumor features, patient constitution and surgeons ability and knowledge often play a crucial role in genesis of local recurrence. Tumor stage is, apparently extremely important risk factor (Kim, Kim et al 2009). Poor differentiation, lymphovascular and perineural invasion are also associated with this phenomenon.…”

Section: Risk Factors Associated With Local Recurrencementioning

confidence: 99%