Prognostic significance of circumferential margin involvement in rectal adenocarcinoma treated with preoperative chemoradiotherapy and low anterior resection

Luna‐Pérez, Pedro; Bustos-Cholico, EfraÍn; Alvarado, Isabel; Maffuz, Antonio; Rodrı́guez-Ramı́rez, Saül; Barrera, Marcos Gutiérrez de la; Labastida, Sonia

doi:10.1002/jso.20232

Cited by 63 publications

(32 citation statements)

References 14 publications

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“…However, some researchers argued that CRM <2 mm was associated with a negative prognosis 18, 19, 20, 21, 22. A CRM clearance of >5 mm and 0.4 mm was proposed by Kelly et al1 in 2009 and Beaufrère et al23 in 2017, respectively.…”

Section: Discussionmentioning

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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Section: Discussionmentioning

confidence: 99%

“…The criterion to define a positive CRM remains unclear. However, some researchers believed that CRM within 2 mm was associated with a negative prognosis 18, 19, 20, 21, 22. In addition, Kelly et al1 argued that a CRM clearance >5 mm should be achieved to optimize curative treatment.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2018

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“…© 2007 American Association for Cancer clincancerres.aacrjournals.org Downloaded from samples collected from the fibrotic area was 9 (median, 7; range, [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22]. Figure 1 shows representative examples of different degrees of tumor regression.…”

Section: Methodsmentioning

confidence: 99%

Circumferential Margin Involvement Is the Crucial Prognostic Factor after Multimodality Treatment in Patients with Locally Advanced Rectal Carcinoma

Gosens

Klaassen

Tan-Go

et al. 2007

Clinical Cancer Research

143

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Purpose: After preoperative (radio)chemotherapy, histologic determinants for prognostification have changed. It is unclear which variables, including assessment of tumor regression, are the best indicators for local recurrence and survival. Experimental Design: A series of 201 patients with locally advanced rectal cancer (cT3/T4, M0) presenting with an involved or at least threatened circumferential margin (CRM) on preoperative imaging (<2 mm) were evaluated using standard histopathologic variables and four different histologic regression systems. All patients received neoadjuvant radiochemotherapy or radiotherapy. The prognostic value of all factors was tested with univariate survival analysis of time to local recurrence and overall survival. Results: Local recurrence occurred in only 8% of the patients with a free CRM compared with 43% in case of CRM involvement (P < 0.0001). None of the four regression systems were associated with prognosis, not even when corrected for CRM status. However, we did observe a higher degree of tumor regression after radiochemotherapy compared with radiotherapy (P < 0.001). Absence of tumor regression was associated with increasing invasion depth and a positive CRM (P = 0.02 and 0.03, respectively). Conclusions: Assessment of CRM involvement is the most important pathologic variable after radiochemotherapy. Although tumor regression increases the chance on a free CRM, in cases with positive resection margins prognosis is poor irrespective of the degree of therapyinduced regression.

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“…Wibe et al [10] reported that a positive circumferential resection margin has a significant and major prognostic impact on the local recurrence rate of rectal carcinoma after TME. However, Luna-Perez et al [19] reported that circumferential resection margin involvement is not correlated significantly with local recurrence of rectal adenocarcinoma (P = 0.33). Hall et al [11] reported that the local recurrence rate of rectal carcinoma with a positive circumferential resection margin is 15% and 11% in of those with a negative circumferential resection margin.…”

Section: Discussionmentioning

confidence: 97%

“…The correlation between circumferential resection margin status and local recurrence of rectal carcinoma is still controversial [10,11,[19][20][21] . Wibe et al [10] reported that a positive circumferential resection margin has a significant and major prognostic impact on the local recurrence rate of rectal carcinoma after TME.…”

Section: Discussionmentioning

confidence: 99%

Risk factors for local recurrence of middle and lower rectal carcinoma after curative resection

Wan²,

Zhao³

et al. 2008

WJG

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AIM:To explore the risk factors for local recurrence of middle and lower rectal carcinoma after curative resection. METHODS: Specimens of middle and lower rectal carcinoma from 56 patients who received curative resection at the Department of General Surgery of Guangdong Provincial People's Hospital were studied. A large slice technique was used to detect mesorectal metastasis and evaluate circumferential resection margin status. The relations between clinicopathologic c h a r a c t e r i s t i c s , m e s o r e c t a l m e t a s t a s i s a n d circumferential resection margin status were identified in patients with local recurrence of middle and lower rectal carcinoma. RESULTS: Local recurrence of middle and lower rectal carcinoma after curative resection occurred in 7 of the 56 patients (12.5%), and was significantly associated with family history (c

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Prognostic significance of circumferential margin involvement in rectal adenocarcinoma treated with preoperative chemoradiotherapy and low anterior resection

Abstract: In patients with rectal cancer treated by preoperative chemoradiation plus total mesorectal excision (TME) and sphincter saving surgery, circumferential margin involvement is associated with high incidence of distant recurrence and cancer-related death.

Cited by 63 publications

References 14 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

Circumferential Margin Involvement Is the Crucial Prognostic Factor after Multimodality Treatment in Patients with Locally Advanced Rectal Carcinoma

Risk factors for local recurrence of middle and lower rectal carcinoma after curative resection

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