Impact of bowel resection margins in node negative colon cancer

Abstract

PurposeSurgical intestinal resection margins in colon cancer are a longstanding debate in terms the optimal distance between the tumor and the colonic section line. The aim of this study is to define the oncological outcomes in relation to surgical margins, measured in terms or recurrence rate, time-to-recurrence, disease-free survival and overall survival in a population of node negative colon cancer patients.MethodsWe conducted a retrospective observational longitudinal single institution study. All patients submitted to colon cancer surgery between January 2006 and December 2010 were analyzed. Only node negative patients were included in the study, with analysis of 215 patient charts, divided in two groups (Intestinal margin lower than 5 cm—group 1; and 5 cm or higher—group 2).ResultsMean age of patients was 70.4 years (±11.7), with a male predominance (57.7%). Group 2 more frequently corresponded to Stage II (83 vs 71%; p = 0.05). Global mean total lymph nodes harvested were 12, and were higher in group II than in group I (13.8 ± 8.2 vs 10.4 ± 5.7; p = 0.001). In terms of time-to-recurrence patients of group 2 had longer time than patients of group 1 (32.3 ± 12.1 vs 21.8 ± 13.8 months; p = 0.03), as well as a lower recurrence rate in group I (13.7 vs 17.2%), despite not statistically significant.ConclusionsThis study has showed that patients with 5 cm or higher bowel resection margins had longer time-to-recurrence that was statistically significant. Recurrence rates were lower in the group of patients with longer surgical margins, however not statistically significant.

Should there be a specific length of the colon-rectum segment to be resected for an adequate number of lymph nodes in cases of colorectal cancers? A retrospective multi-center study

“…It has also been suggested that metastatic lymph nodes may be found approximately 8 to 10 cm of the colonic segment around the tumor, and hence the removal of the distal and proximal surgical margin with a 5 cm safety margin is recommended (17). In our study, median length of the proximal margin was found to be 10 cm, while mean distal margin length was 6.5 cm.…”

Equivalent Operative Outcomes for Emergency Colon Cancer Resections Among Acute Care Surgeons and Specialists in Colorectal Surgery

“…Furthermore, Rocha et al identify that location of tumor also correlates with margin status, with sigmoid resections more likely to have shorter margins and fewer lymph nodes retrieved, with lymphatic involvement as a significant risk factor for recurrence. 12 With regard to coordination of care in the emergent setting, our analysis suggests that emergent cases are provided equivalent initiation of oncology care for those with advanced disease (margin positive, node positive, metastatic, or other high-risk patients such as elevated CEA and poorly differentiated tumor). 13 While it was initially thought that emergent cases would be at a disadvantage in terms of oncology care due to new diagnosis and less case volume for referrals, the data analysis suggests an equivalent coordination of care for all colon resections at our institution.…”

“…Furthermore, Rocha et al identify that location of tumor also correlates with margin status, with sigmoid resections more likely to have shorter margins and fewer lymph nodes retrieved, with lymphatic involvement as a significant risk factor for recurrence. 12…”

Colonic lipoma mimicking malignancy and presenting as an intussusception: A rare case report

“…As far as our patient was concerned, we performed an intraoperative frozen section, confirming tumor-free margins of 5 cm [ 14 ]. We then restored the ascending-transverse intussusception and performed an extended right hemicolectomy with ileocolic anastomosis.…”